内科

【摘要】目的 对比合并狼疮性肾炎（LN）与未合并LN的系统性红斑狼疮（SLE）患者的人口学、临床及血清学特征，并初步探索与合并LN相关的多因素关联模型。方法采用横断面研究设计，回顾性分析2012年8月至2022年8月深圳市人民医院712例SLE住院患者的资料。根据是否合并LN将患者分为LN组（n=275）和无LN组（n=437）。采用t检验、Mann-Whitney U检验或χ²检验进行组间比较。随后，为探索多因素关联，将单因素分析中有统计学意义的变量纳入logistic回归模型。结果 712例SLE患者中，共275例合并LN（38.62%）。单因素分析结果显示，LN组年龄、血红蛋白水平、血细胞比容、血清白蛋白水平、血清球蛋白水平、白蛋白/球蛋白比值、肾小球滤过率、补体C3水平、血清免疫球蛋白（Ig）A水平、血清IgG水平，以及抗dsDNA抗体、抗核小体抗体、抗组蛋白抗体、抗Sm抗体、抗U1-snRNP抗体阴性患者占比均低于无LN组；LN组24 h尿蛋白定量、白细胞计数、中性粒细胞百分比、红细胞沉降率、血尿素氮水平、血肌酐水平、血清总胆固醇水平、低密度脂蛋白胆固醇水平、系统性红斑狼疮疾病活动指数（SLEDAI）、系统性红斑狼疮疾病活动度评分（SLE-DAS），以及合并高血压、心血管受累、心包积液、血尿、脓尿、蛋白尿、消化系统受累、肠系膜血管炎、腹腔积液、血液系统受累、淋巴细胞增多症患者占比高于无LN组（均P<0.05）。多因素logistic回归分析结果显示，在SLE患者中，补体C3水平降低、血清IgG水平降低、血清IgA水平降低、SLE-DAS升高、抗组蛋白抗体阳性和抗U1-snRNP抗体阳性与合并LN均存在独立统计学关联（均P<0.05）。结论合并LN的SLE患者与不合并者在临床特征上存在显著差异，其普遍呈现出更活跃的免疫状态（补体C3消耗性降低）、更严重的肾脏损伤表现（如蛋白尿、高血压患病率更高）及更高的SLE-DAS。多因素模型进一步勾勒了这些特征间的内在关联结构，为未来在前瞻性队列中验证这些指标的预测价值提供了重要的初步证据和理论基础。

Objective To compare the demographic, clinical, and serological characteristics between systemic lupus erythematosus (SLE) patients with and without lupus nephritis (LN), and to preliminarily explore a multifactorial association model related to the presence of LN. Methods A cross-sectional study design was used to retrospectively analyze the data of 712 hospitalized SLE patients at Shenzhen People's Hospital from August 2012 to August 2022. According to the presence of LN, patients were divided into an LN group (n=275) or a non-LN group (n=437). The t-test, Mann-Whitney U test, or χ² test was used for intergroup comparisons, as appropriate. Subsequently, to explore multifactorial associations, variables with statistical significance in the univariate analysis were included in a logistic regression model. Results Among the 712 SLE patients, 275 (38.62%) had LN. Univariate analysis results showed that the LN group had younger age and lower values than the non-LN group in terms of hemoglobin level, hematocrit, serum albumin level, serum globulin level, albumin/globulin ratio, glomerular filtration rate, complement C3 level, serum immunoglobulin (Ig) A level, serum IgG level, as well as the proportions of patients negative for anti-dsDNA antibody, anti-nucleosome antibody, anti-histone antibody, anti-Sm antibody, and anti-U1-snRNP antibody; conversely, the LN group had higher values than the non-LN group in terms of 24-hour urinary protein quantification, white blood cell count, neutrophil percentage, erythrocyte sedimentation rate, blood urea nitrogen level, serum creatinine level, serum total cholesterol level, low-density lipoprotein cholesterol level, systemic lupus erythematosus disease activity index (SLEDAI), systemic lupus erythematosus disease activity score (SLE-DAS), as well as the proportions of patients with hypertension, cardiovascular involvement, pericardial effusion, hematuria, pyuria, proteinuria, digestive system involvement, mesenteric vasculitis, ascites, hematological involvement, and lymphocytosis (all P<0.05). Results of multivariate logistic regression analysis showed that decreased complement C3 level, decreased serum IgG level, decreased serum IgA level, elevated SLE-DAS, positivity for anti-histone antibody, and positivity for anti-U1-snRNP antibody were independently and statistically associated with the presence of LN in SLE patients (all P<0.05). Conclusions SLE patients with LN exhibit significant differences in clinical characteristics compared to those without LN. Those with LN generally present with a more active immune status (consumptive decrease in complement C3), more severe renal damage manifestations (e.g., higher prevalence of proteinuria and hypertension), and higher SLE-DAS. The multivariate model further outlines the intrinsic associative structure among these features, providing important preliminary evidence and a theoretical basis for validating the predictive value of these indicators in future prospective cohorts.

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