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| 目的：探讨初诊狼疮性肾炎（LN）患者抗核抗体（ANA）核型、最高滴度及核型叠加与肾活检NIH活动/慢性指数（AI/CI）及基线肾功能的关联。方法：纳入199例初诊肾活检患者，提取ANA核型与最高滴度（log2）、细胞浆颗粒型及核型叠加（单/双/≥三），收集LN分型、AI/CI与ln肌酐。以AI≥10为主要结局，采用秩和/χ2检验及多因素Logistic/线性回归校正年龄、性别、BMI。结果：细胞核颗粒型、细胞核均质型和细胞浆颗粒型分别占73.4%、58.3%和44.2%，双核型叠加占51.8%。细胞浆颗粒型阳性者≥三核型更常见（34.1%比3.6%，P<0.001），但LN分型分布差异不显著。多因素Logistic回归显示：细胞浆颗粒型与AI≥10风险降低相关（OR=0.37，95%CI 0.17–0.83），最高滴度每增加1个log2单位OR=0.72（0.57–0.92），≥三核型叠加OR=4.23（1.29–13.88）；核型叠加与AI连续值呈独立正相关。ln肌酐模型中细胞浆颗粒型与较低肌酐相关（β=-0.27，P=0.012）。结论：ANA核型叠加程度提示肾组织活动性增高；细胞浆颗粒型与高活动性风险降低及更好基线肾功能相关，可作为基线风险分层的补充指标。 |
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shen yue yang
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Youjiang Medical University For Nationalities
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| Abstract: |
| Objective? To investigate the associations of antinuclear antibody (ANA) immunofluorescence patterns, maximum titers, and pattern overlap with renal histologic activity, chronicity, and baseline renal function in patients with newly diagnosed lupus nephritis (LN). Methods? In this single-center cross-sectional study, 199 consecutive adults with newly diagnosed LN who underwent renal biopsy between January 2014 and September 2024 were enrolled. ANA on HEp-2 cells was classified into eight patterns, and the presence of each pattern, maximum titer (log?), cytoplasmic speckled pattern, and the number of coexisting patterns (single, double, ≥3) were recorded. Renal pathology was evaluated according to the ISN/RPS classification and the modified NIH activity index (AI) and chronicity index (CI). The primary outcome was high histologic activity, defined as AI ≥10. Mann–Whitney U test, χ2 test, and multivariable logistic and linear regression were used to assess the associations between ANA-related variables and AI, CI, and the natural log-transformed serum creatinine (lnCr), adjusting for age, sex, and body mass index. Results? The nuclear speckled (73.4%), homogeneous (58.3%), and cytoplasmic speckled (44.2%) patterns were the most frequent, and double-pattern overlap was predominant (51.8%). Patients with the cytoplasmic speckled pattern more often exhibited ≥3 coexisting patterns than those without this pattern (34.1% vs. 3.6%, P＜0.001), whereas the distribution of LN histologic classes was similar between groups. In multivariable logistic regression, the cytoplasmic speckled pattern was independently associated with a reduced risk of AI ≥10 (OR 0.37, 95% CI 0.17–0.83), and each 1-unit increase in log? ANA titer was associated with lower odds of AI ≥10 (OR 0.72, 95% CI 0.57–0.92), while ≥3 pattern overlap was independently associated with a higher risk of AI ≥10 (OR 4.23, 95% CI 1.29–13.88). The number of overlapping patterns was also positively associated with AI as a continuous variable. In the lnCr model, the cytoplasmic speckled pattern correlated with lower creatinine levels (β = ?0.27, P = 0.013). Conclusion In newly diagnosed LN, the extent of ANA pattern overlap appears to reflect renal histologic activity better than titer alone, and the presence of ≥3 coexisting patterns identifies patients at higher risk of severe histologic activity. Conclusion? The cytoplasmic speckled pattern is associated with a lower risk of high AI and more favorable baseline renal function, and may serve as a simple adjunctive marker for baseline renal risk stratification in LN. |
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