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Objective:To explore the risk factors and time distribution of renal relapse in patients with lupus nephritis (LN).Methods:Clinical, pathological characteristics and long-term outcomes of LN patients who were diagnosed and followed in Jinling Hospital from January 2004 to December 2008 were retrospectively analyzed. The patients were divided into relapse group and non-relapse group. The differences of clinical pathological characteristics between the two groups were compared. The multivariate Cox proportion risk model was used to analyze the risk factors affecting renal relapse in LN. The risk factors and time distribution of renal relapse were analyzed with annual relapse risk-time curve.Results:A total of 814 patients with LN were included in the study, with 419 cases (51.5%) of complete remission and 395 cases (48.5%) of partial remission. The age was (30.24±10.90) years old, and there were 112 males (13.8%). There were 367 patients suffering renal relapse. The time of first renal relapse was (3.21±2.70) years. The results of multivariate Cox regression showed that age ( HR=0.976, 95% CI 0.966-0.986, P<0.001), renal pathological activity index (AI) score ( HR=1.039, 95% CI 1.013-1.065, P=0.003), remission status after induction treatment ( HR=0.671, 95% CI 0.504-0.894, P=0.006), 24 h urinary protein quantitation ( HR=1.297, 95% CI 1.115-1.508, P=0.001), anti-double strand DNA antibody (A-dsDNA, HR=1.450, 95% CI 1.139-1.846, P=0.003) and complement C3 ( HR=0.223, 95% CI 0.128-0.389, P<0.001) were correlated with increasing risk of renal relapse in LN. The annual relapse risk profile was unimodal, with a peak period of the second year after maintenance treatment. Similar patterns of relapse were presented in subgroup analysis. Conclusions:Age, renal pathological AI score, remission status after induction therapy, 24 h urine protein, A-dsDNA and blood complement C3 are the influencing factors for relapse of LN patients. The peak period of renal relapse in patients with LN is in the second year of maintenance therapy.
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Objective The treatment of anti-neutrophil cytoplasmic antibodies ( ANCA) associated vasculitis ( AVV) such as mycophenolate mofetil ( MMF ) can improve the remission rate, however, it also results in high recurrence rate and high incidence of adverse reaction related to the treatment.The article was to observe the clinical efficacy and safety of multi-target therapy ( MT ) in the treatment of AAV with renal involvement. Methods Retrospective observation was made on 7 AVV patients treated with multi-target therapy in our department from June 2009 to October 2013.The pa-tients (1 male, 6 females) aged from 21 to 54 years were accompa-nied with renal damage and serum creatinine (SCr≤3 mg/dL).All patients had positive myelopeeroxidase-ANCA (MPO-ANCA), high-grade proteinuria and hematuria.4 patients had elevated SCr (1.47-2.94 mg/dL) with EGFR90 mL/min in 2 patients and EGFR60 mL/min) .At the end of follow-up, the EGFR expres-sion was normal in 4 patients, 60-90 mL/min in 1 patient and less than 60 mL/min in 2 patients, without end stage renal disease. ANCA level turned to normal in 3 patients and significantly decreased in 4 patients.No patients had adverse reaction, died, or re-lapsed during the follow-up. Conclusion MT is effective in the control of renal activities of AVV patients with mild or moderate re-nal function damage.It attributes to great improvement of renal function and urine protein, as well as good tolerance.However, pro-spective study is required to confirm the efficacy of this new therapy.
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With the development of computer technique, Excel office software is widely applied in the management of clinical teaching. According to the problems existing in the clinical teaching management of our college, Excel electronic software is accepted to reform the present management measures. Its designation, essential archives establishment, method, result, analysis and discussion are introduced definitely in this paper.