[Radiological progression and life quality analysis in ankylosing spondylitis patients using etanercept/methotrexate combination therapy].

OBJECTIVE: To analyze the relationship between the radiological progression and quality of life in ankylosing spondylitis (AS) patients using etanercept/methotrexate (MTX) combination therapy. METHODS: A total of 153 AS cases fulfilling the 1984 modified New York diagnostic criteria were reviewed. All patients received radiological evolution at baseline and during a follow-up period. Radiological progression, clinical remission and life quality were recorded and analyzed for their relations. RESULTS: The radiological assessments of mSASSS (modified Stoke ankylosing spondylitis spine score) were recorded at baseline, 3, 6 & 12 months after treatment. Life quality assessments were recorded with SF (short-form)-36 simultaneously. No significant radiological improvement was observed at the end points. However, most patients reported a significant improvement of life quality after a combination therapy of etanercept/MTX. BASDAI (Bath ankylosing spondylitis disease activity index), C-reactive protein and erythrocyte sedimentation rate demonstrated similar trends. With no relevance with mSASSS, life quality was significantly correlated with disease activity and pain control. CONCLUSION: The combination therapy of etanercept/MTX greatly improves life quality in AS patients. Yet clinical remission and pain control offer no hint of a suspension of radiological progression. Routine radiological assessment is required throughout the follow-up period of AS even if life quality index reaches a high level.

[Risk factors affecting the long-term outcome of IgA nephropathy].

OBJECTIVE: To study the risk factors predicting long-term renal survival of IgA nephropathy in Chinese. METHODS: Clinical and pathological data of 317 patients (124 males and 193 females) with IgA nephropathy confirmed by renal biopsy in our center from January 1987 to February 2003 were reviewed retrospectively and were correlated with outcomes. A semiquantitative scoring system was used to evaluate individual pathological lesion of the kidney. Patients were followed for at least 6 months and doubling of serum creatinine level was defined as endpoint of follow-up. Renal survival was calculated by Kaplan-Meier survival analysis and risk factors of progression were analyzed by using univariate and multi-variate Cox regression models. RESULTS: The average age at renal biopsy was (30.1 +/- 10.9) years and the average duration from onset of disease to the time of biopsy was (20.1 +/- 33.7) months. Thirty-two percent of the patients had 24 h-urinary protein excretion greater than 1.0 g at the time of biopsy. Thirty-two percent of the patients had hypertension and 20.8% had renal insufficiency. Thirty-five percent of the patients were of Lee's grade IV or above and 20.5% presented with small proportion of crescent formation (usually less than 20%). Patients were followed for an average duration of (43.5 +/- 32.2) months with 39 patients (12.3%) reaching the endpoint. The 1-, 3-, 5- and 10-year renal survival was 99.5%, 93.1%, 84.5% and 60.1% respectively. Univariate Cox regression analysis revealed that longer duration of the disease before biopsy, serum creatinine > 115 micromol/L, proteinuria > 1.0 g/d, hypertension, Lee's grading of IV-V, moderate-severe glomerulosclerosis, crescent formation, moderate-severe interstitial fibrosis and renal arteriolar lesion were risk factors of disease progression, with an odds ratio of 1.007, 9.61, 7.31, 3.97, 5.41, 5.78, 4.65, 14.05 and 2.28 respectively (P < 0.001). Episodic macro-hematuria had an odds ratio of 0.194 (P < 0.05). Age, sex, serum cholesterol and triglyceride level had no significant impact on prognosis. Proteinuria, elevated serum creatinine, glomerulosclerosis, crescent formation and interstitial fibrosis were confirmed to be independent risk factors by multi-variate Cox regression model while the remaining variables were not statistically significant. Patients with both renal insufficiency and proteinuria greater that 1.0 g/24 h at the time of biopsy had a very poor 5-year renal survival (41.8%). CONCLUSIONS: Proteinuria, renal insufficiency, glomerulosclerosis, crescent formation and interstitial fibrosis were independent risk factors predicting the renal survival. IgA nephropathy presented with proteinuria, hypertension and crescent formation may need intervention.

[Improvement of left ventricular hypertrophy by anemic-correcting erythropoietin therapy in chronic renal insufficiency].

OBJECTIVE: Left ventricular hypertrophy (LVH) is an independent predictor of morbidity and mortality in dialysis patients. It remains unclear whether efforts to correct anemia in patients with mild-to-moderate chronic renal insufficiency (CRI) can reverse LVH. This prospective multi-center Chinese cohort study evaluates left ventricular mass index (LVMI) evolution in anemic CRI patients with or without recombinant human erythropoietin (rHuEPO) therapy. METHODS: Six centers enrolled 158 patients with serum creatinine from 147 to 400 micromol/L, and 86 of whom with hemoglobin (Hb) levels < 110 g/L received rHuEPO (Group A). Forty patients with comparable Hb levels (< 110 g/L) but did not receive rHuEPO (Group B) and those with Hb >/= 110 g/L (Group C, n = 32) were served as controls. Echocardiographic studies were performed to evaluate LVMI at baseline and every 3 months during a two-year period. RESULTS: At baseline, the prevalence of LVH was 72.1% in Group A, 72.5% in Group B and 59.4% in Group C. LVMI was inversely correlated with Hb levels (r = -0.70, P < 0.01). There was no difference in age, gender, aetiology of renal failure, blood pressure (BP) and cardiovascular risk factors between the 3 groups. The administration of rHuEPO in Group A significantly increased Hb levels from (93.8 +/- 14.6) g/L to (111.2 +/- 10.3) g/L and decreased LVMI from (142.6 +/- 25.7) g/m(2) to (132.4 +/- 18.5) g/m(2). The prevalence of LVH decreased 16.3% after a partial correction of anemia at 24 months, whereas Hb levels in controls (Group B and Group C) tended to decrease and LVMI significantly increased compared with baseline. The prevalence of LVH was significantly increased in Group B and C after 24 months. The percentage of patients whose serum creatinine level doubled during the follow-up was 3.4% in Group A, 15.0% in Group B and 9.4% in Group C, the difference between Group A and Group B being significant (P < 0.05). In addition, good BP control was obtained without any adverse effects. CONCLUSION: High prevalence of LVH was present in pre-dialysis CRI patients, which is associated with severity of anemia. Early treatment of anemia with rHuEPO can reverse LVH in CRI patients.