Kev Txhim Kho Ntawm Lupus Nephritis Suboptimal Response Prediction Tool Siv Lub Raum Histopathological Thiab Clinical Laboratory Variables Thaum Lub Sijhawm Kev Ntsuas

Lindsay N Helget,^1,2 David J Dillon,¹ Bethany Hmab,³Laura P Parks,¹ Sally E Tus kheej,⁴Evelyn T Bruner⁴ Evan E Oates,⁵Jim C Oates

TSAB NTAWV

Lub hom phiajLupus nephritis (LN) yog ib qhotiv thaiv kab mobcomplex-mediated glomerular thiab tubulointerstitial kab mob hauv cov neeg mob SLE. Kev twv ua ntej ntawm qhov tshwm sim ntawm qhov pib ntawm LN kev kuaj mob tuaj yeem coj kev txiav txim siab txog kev siv tshuaj xyuas thiab kev kho kom zoo rau kev kho mob. Tam sim no, tsis muaj cov qauv kev kawm tshuab ntawm cov txiaj ntsig tshwm sim. Ntau qhov txiaj ntsig kev ua qauv ua haujlwm tau siv cov qauv tsis sib xws lossis cov qauv tsim tawm tab sis raug txwv los ntawm tus kab mob heterogeneity. Peb xav tias kev sib xyaw ua ke ntawm cov txiaj ntsig ntawm lub raum pathology thiab cov ntaub ntawv kuaj mob niaj hnub tuaj yeem siv los txhim kho thiab hla kev siv lub tshuab muaj txiaj ntsig kev kawm kev txiav txim siab ntxov ntxov uas kwv yees LN cov txiaj ntsig ntawm kwv yees li 1 xyoos.

Cov txheej txheemTxhawm rau hais txog qhov kev xav no, cov neeg mob uas muaj LN los ntawm cov ntawv teev npe ntev ntev ntawm Medical University of South Carolina tau tso npe nyob nruab nrab ntawm 2003 thiab 2017 tau txheeb xyuas yog tias lawv muaj lub raum biopsies nrog International Society of Nephrology / Renal Pathology Society kev faib tawm cov kab mob. Cov txiaj ntsig ntawm kev kuaj mob thaum lub sijhawm kuaj mob thiab cov txiaj ntsig tau hloov pauv ntawm kwv yees li 1 xyoos tau sau tseg. Cov qauv kev kawm tshuab tau tsim thiab hla-validated los kwv yees cov lus teb tsis zoo.

Cov txiaj ntsigFive machine learning models predicted suboptimal response status in 10 times cross-validation with receiver operating characteristics area under the curve values >0.78. Qhov kev kwv yees feem ntau yog qhov sib txawv ntawm qhov mob sib kis, kab mob sib kis, cov qhab nia ua haujlwm, thiab cov qhab nia ntev ntawm lub raum pathology thiab cov zis protein-rau-creatinine piv, suav cov qe ntshav dawb, thiab hemoglobin los ntawm cov chaw kuaj mob. Cov cuab yeej siv hauv lub vev xaib tau tsim los rau cov kws kho mob nkag mus rau hauv cov chaw kuaj mob hauv qab no thiab cov kab mob histopathology sib txawv los tsim cov qhab nia ntawm cov lus teb tsis zoo.

XausMuab qhov heterogeneity ntawm kev nthuav qhia kab mob hauv LN, nws yog ib qho tseem ceeb uas cov qauv kev pheej hmoo yuav suav nrog ntau cov ntaub ntawv. Daim ntawv tshaj tawm no muab thawj zaug cov ntaub ntawv pov thawj-ntawm-lub tswv yim uas siv tsib tus qauv kev kwv yees thiab ua kom yooj yim rau kev nkag siab ntawm lawv los ntawm kev siv web-based.

Hu rau:joanna.jia@wecistanche.com

Cistanche tshuaj ntsuabdeserticola tiv thaivraumkab mob, nyem qhov no kom tau txais cov qauv

Taw qhia

Lupus nephritis (LN) yog ib qho kev tiv thaiv kab mob tsis sib haum xeeb hauv glomerular thiab tubulointerstitial kab mob hauv cov neeg mob SLE. Kwv yees li 50 feem pua ​​​​ntawm cov neeg mob SLE tsimraum-Cov teeb meem ntsig txog, suav nrog LN, thiab txog li 48 feem pua ​​​​ntawm cov neeg uas muaj tus kab mob sib kis tuaj yeem ua rau mob raum raum kawg hauv 5 xyoos ntawm kev kuaj mob ntawm African-Americans.1 Lub Tsev Kawm Qib Siab American ntawm Rheumatology (ACR) tam sim no pom zoo kom hloov kho. Thaum cov neeg mob uas muaj LN yog suav tias yog cov tsis teb tom qab 6 lub hlis ntawm kev kho induction.2 Cov kws kho mob siv ntau hom ntshav cov cim, suav nrog C3, C4, anti-ob-stranded DNA (anti-dsDNA), thiab creatinine, nrog rau cov zis protein. -to-creatinine piv thiab sediment los saib xyuas cov lus teb rau kev kho mob, tab sis cov lus teb rau kev kho tsis tau txhais nyob rau hauv cov lus qhia.2 Thaum nyob rau hauv no 6- hli sim ntawm induction therapy, cov neeg mob uas tsis teb yuav tsim irreversible ntxiv raum. kev puas tsuaj. Ib qho cuab yeej txhawb kev txiav txim siab raws li cov qauv kev kawm tshuab yuav pab tau rau kev txiav txim siab cov yam ntxwv ntawm cov neeg mob uas tsis tshua muaj feem cuam tshuam rau kev kho induction. Tam sim no, tsis muaj cov qauv kev kawm siv tshuab tau zoo ntawm 1-cov txiaj ntsig xyoo tau tsim. Univariate lossis linear modeling tsis tau kwv yees qhov tshwm sim zoo nyob rau hauv cov kab mob heterogeneous no.

Peb xav tias kev sib xyaw ua ke ntawm cov txiaj ntsig ntawm lub raum pathology thiab cov ntaub ntawv kuaj mob niaj hnub tuaj yeem siv los txhim kho thiab hla kev lees paub qhov kev txiav txim siab ntawm LN thaum ntxov uas kwv yees cov lus teb tsis zoo ntawm kwv yees li 1 xyoo hauv LN.

Txoj kev

Cov neeg mob

Cov ntaub ntawv tus neeg mob tau muab los ntawm Medical University of South Carolina (MUSC) Core Center for Clinical Research (CCCR) yav tom ntej longitudinal cohort. Cov ntaub ntawv CCCR tau txhawb nqa los ntawm NIH nyob rau hauv P30 mechanism thiab yog ib daim ntawv teev npe ntev thiab biorepository ntawm feem ntau African-American cov neeg mob nrog SLE. Cov neeg mob xaiv tau ntsib ntawm ACR lossis SLE International Cooperating Clinics cov txheej txheem rau SLE, 3 4 tau raug soj ntsuam los ntawm tus kws kho mob rheumatology ntawm MUSC thiab pom zoo rau npe rau hauv pawg pab pawg. Cov ntaub ntawv yav tom ntej longitudinal cohort tau tsim nyob rau xyoo 2003. Cov ntaub ntawv kab mob thiab cov ntaub ntawv rau lub raum biopsy tau nkag mus rau yav tom ntej, tab sis qee qhov tau ntxiv rov qab los ntawm daim ntawv tshuaj xyuas.

cistanchekho taumob raum tsis ua haujlwm

Cov txheej txheem suav nrog

Cov neeg mob kuj raug xaiv yog tias lawv tau hloov kho International Society of Nephrology/Renal Pathology Society (ISN/RPS), active class, I, II, III, IV los yog V nephritis los ntawm histopathology nyob rau hauv thawj qhov kev nthuav qhia ntawm LN los yog nrog ib tug zuj zus ntawm LN qhia. rov ua biopsy ntawm 2003 thiab 2017.5 Tsuas yog cov neeg mob uas muaj cov ntaub ntawv kuaj ua tiav muaj nyob rau lub sijhawm ntawm lub raum biopsy thiab kwv yees li 12 lub hlis (7-24 lub hlis) tom qab lub raum biopsy tau suav nrog hauv txoj kev tshawb no.

Laboratory tsom xam

Cov nqi kuaj tau txais los ua ib feem ntawm kev saib xyuas tus neeg mob. Kev ntsuam xyuas rau 24-teev cov zis protein, protein rau-creatinine piv, cov ntshav creatinine, albumin, hemoglobin, cov qe ntshav dawb suav, platelet suav, anti dsDNA, C3, thiab C4 tau ua los ntawm Clinical Laboratory Improvement Amendments-certified central laboratories ntawm MUSC, LabCorp, lossis cov chaw kuaj mob sab nraud. Qhov kwv yees glomerular filtration rate (eGFR) tau txiav txim los ntawm kev siv lubNtevLub raumKab mobEpidemiology Collaboration (CKD-EPI) equation.6

Pathology tsom xam

Lub raum biopsies tau nyeem los ntawm ib tug ntawm ob lub raum pathologist ntawm MUSC (SES lossis ETB) siv 2018 hloov kho ISN/ RPS kev ua (0–24) thiab ntev (0–12 ) index ntsiab (txhua tus qhab nia 0-3 rau 0 feem pua ​​,<25%, 25%–50%="" and="">50 feem pua ​​​​kev koom tes).5 suav nrog hauv qhov ntsuas kev ua haujlwm yog endocapillary hypercellularity, karyorrhexis, fibrinoid necrosis, hyaline deposits, cellular los yog fibro cellular crescents, thiab interstitial o. Cov qhab nias tau muab ob npaug rau crescents thiab necrosis. Muaj nyob rau hauv qhov ntsuas qhov ntev yog tag nrho cov qhab nia glomerulosclerosis, fibrous crescents, tubular atrophy, thiab interstitial fibrosis.

Kev tuav ntaub ntawv

Cov ntaub ntawv rau CCCR cov ntaub ntawv tau raug txiav txim ncaj qha rau hauv REDCap database siv Data Transfer Service7 txhawm rau tshem tawm cov ntawv sau tsis raug. Qee qhov chaw kuaj mob tau muab rho tawm los ntawm daim ntawv tshuaj ntsuam xyuas ntawm cov ntaub ntawv kho mob hluav taws xob thiab cov ntaub ntawv soj ntsuam kuaj thiab tau nkag mus rau hauv cov ntaub ntawv manually. Ib tug tsib feem pua ​​​​ob-nkag nkag ntawm cov ntaub ntawv abstracted tau ua kom paub tseeb tias qhov yuam kev transcription yog<5%. pathology="" reports="" were="" manually="" abstracted="" and="" entered="" into="" the="" registry="" if="" not="" already="">

Kev txheeb cais

Cov txiaj ntsig sib txawv yog qhov tsis ua tiav rau kev kho mob ntawm kwv yees li 1 xyoos. Lub sijhawm no tau xaiv, raws li qhov sib txawv ntawm cov lus teb ntawm 1 xyoo yog kwv yees ntawm cov lus teb mus sij hawm ntev hauv MAINTAIN thiab Euro-Lupus Nephritis Trials.8 Teb tau txhais los ntawm kev hloov kho ntawm ACR cov qauv lus teb.9 Cov kev hloov kho rau cov qauv no tau piav yav dhau los los ntawm Wofsy et al. 10 luv luv, qhov kev hloov pauv no suav nrog kev ua kom cov zis protein-rau-creatinine piv ntawm<0.5 at="" approximately="" 1="" year="" and="" achieving="" an="" egfr="" of="" 90="" or="" an="" improvement="" of="" at="" least="" 15%="" from="" baseline.="" the="" suboptimal="" response="" outcome="" was="" defined="" by="" the="" lack="" of="" achieving="" complete="" response="" as="" defined="" above.="" thus,="" the="" outcome="" includes="" non-responders="" and="" partial="" responders.="" variables="" collected="" in="" the="" data="" included="" patient="" sex,="" age="" at="" the="" time="" of="" biopsy,="" proliferative="" disease="" (isn/rps="" classes="" iii="" or="" iv,="" y/n),="" mesangial="" disease="" (isn/="" rps="" class="" i="" or="" ii,="" y/n),="" membranous="" disease="" (isn/rps="" class="" v,="" y/n),="" activity="" score="" (0–3),="" chronicity="" score="" (0–3),="" interstitial="" fibrosis="" (0–3),="" interstitial="" inflammation="" (0–3),="" number="" of="" glomeruli="" evaluated,="" crescents="" (number),="" crescent-toglomeruli="" ratio="" (0–3×2),="" necrosis="" (0–3×2),="" urine="" proteinto-creatinine="" ratio,="" egfr="" by="" the="" ckd-epi="" formula="" (egfr,="" ml/min/1.73="" m²),6="" serum="" creatinine="" (mg/dl),="" dsdna="" (iu),="" c3="" (mg/dl),="" c4="" (mg/dl),="" the="" white="" blood="" cells="" count="" (k/µl),="" platelet="" count="" (k/µl),="" hemoglobin="" (g/dl),="" serum="" albumin="" (mg/dl),="" prednisone="" (y/n),="" hydroxychloroquine="" (y/n),="" mycophenolate="" mofetil/mycophenolic="" acid="" (y/n),="" cyclophosphamide="" (y/n),="" rituximab="" (y/n),="" azathioprine="" (y/n)="" and="" number="" of="" medications.="" since="" the="" data="" were="" retrospective="" and="" not="" prospectively="" randomized,="" immunosuppressants="" used="" for="" induction="" are="" subject="" to="" bias="" by="" indication="" and="" were="" not="" considered="" predictive.="" they="" were="" excluded="" from="" consideration="" during="" model="" development="" for="" clinical="" use,="" as="" their="" presence="" might="" imply="" that="" the="" choice="" of="" induction="" therapy="" based="" on="" the="" modeling="" might="" affect="" the="" outcomes.="" descriptive="" statistics="" were="" calculated="" for="" all="" participant="" characteristics="" by="" treatment="" response="" category.="" univariate="" associations="" between="" all="" baseline="" characteristics="" and="" treatment="" response="" were="" evaluated="" using="" a="" series="" of="" logistic="" regression="">

Lub hom phiaj ntawm txoj kev tshawb fawb no yog txhawm rau txheeb xyuas qhov sib txawv ntawm cov kev kwv yees los ntawm cov neeg mob cov pej xeem thiab cov chaw kuaj mob hauv paus thiab cov ntaub ntawv biopsy uas ua rau muaj txiaj ntsig zoo rau kev kwv yees ua tau zoo rau cov qauv kev kwv yees ntau yam sib txawv ntawm cov lus teb tsis zoo ntawm kwv yees li 1 xyoos. Cov qauv kev faib tawm ntau yam uas suav nrog hauv txoj kev tshawb no suav nrog logistic regression (LR), kev faib tawm thiab cov ntoo regression (CART), random hav zoov (RF), txhawb nqa vector tshuab nrog linear, polynomial, thiab Gaussian kernels (SVML, SVMP, thiab SVMR, ntsig txog), naïve Bayes (NB) thiab Artificial Neural Networks (ANN). RF qauv tau haum siv 'randomForest' pob; LR qauv tau haum siv 'stats' pob khoom; SVMs thiab NB qauv tau haum siv 'e1071' pob; ANNs qauv tau haum rau siv 'net' muaj nyob rau hauv R.11 12 Tuning parameters rau cov qauv sib txawv txiav txim siab tau xaiv ua ntej tsim cov qauv. Kev tshawb nrhiav thawj zaug ntawm txhua qhov sib xyaw ua ke ntawm txog 20 qhov sib txawv tau raug txiav txim siab. Txawm li cas los xij, cov txiaj ntsig los ntawm kev tshawb fawb no pom qhov kev ua tau zoo tshaj plaws nruab nrab tshwm sim thaum cov qauv suav nrog yim qhov sib txawv (online ntxiv daim duab 2). Yog li, qhov kev xaiv sib txawv tau ua los ntawm kev tshuaj xyuas tag nrho ntawm txhua qhov ntawm yim lossis tsawg dua tus kwv yees. Tus lej pib no tau txiav txim siab rau txhua txoj hauv kev ua qauv los ua kom cov qauv muaj txiaj ntsig zoo hauv qhov chaw kho mob tsis khoom. Tshwj xeeb tshaj yog, kev kwv yees ua tau zoo rau txhua tus qauv ntawm cov khoom kwv yees tau ua los ntawm kev siv 10-fold cross-validation (CV) mus kom ze. Kaum-fold CV faib cov ntaub ntawv rau hauv 10 subsets. Cov qauv raug cob qhia siv 9/10 ntawm cov ntaub ntawv thiab sim ntawm qhov seem 1/10 ntawm cov ntaub ntawv, thiab qhov no rov ua dua rau txhua qhov subset. Qhov chaw hla-validated nyob rau hauv txoj kab nkhaus (cvAUC) yog qhov nruab nrab AUC suav rau txhua ntu ntawm 1/10 ntawm cov ntaub ntawv tsis suav nrog thaum lub sijhawm tsim qauv thiab tau pom tias muaj zog dua li kev siv ib qho kev cob qhia-kev sim ntsuas. 13 Lub hom phiaj yog txhawm rau txheeb xyuas qhov me me ntawm cov neeg twv ua ntej nrog qhov kev twv ua tau zoo nyob thoob plaws cov qauv.14 Kev twv ua ntej kev ua tau zoo tau ntsuas los ntawm 10-fold cvAUC thiab qhov zoo tshaj plaws ntawm yim qhov sib txawv tau raug xaiv los ua cov txheej txheem uas ua rau qhov nruab nrab siab tshaj plaws cvAUC hla txhua tus qauv. rhiab heev, qhov tshwj xeeb, tus nqi kwv yees zoo, thiab qhov kev kwv yees tsis zoo tau txiav txim siab rau kev xaiv qhov pib rau qhov kwv yees qhov tshwm sim ntawm qhov tsis teb rov qab los ntawm txhua tus qauv. Tag nrho cov kev ntsuam xyuas tau ua nyob rau hauv R V.4.0.2. Ib qho R-Shiny, cov cuab yeej web-based tau tsim raws li cov qauv tsim tau raug xaiv.

TSEEM CEEB

Hauv kev sau npe, 149 tus neeg mob muaj cov ntaub ntawv rau lub raum biopsy muaj nyob nruab nrab ntawm 2003 thiab 2017. Ntawm cov no, 83 tus neeg mob nrog LN muaj cov hauv paus thiab kwv yees li ntawm 1- xyoo rov qab cov ntaub ntawv lub raum teb ntawm 7.5 thiab 24 lub hlis (online ntxiv daim duab 1) . Peb nrog kev ua raws<7 months="" and="" four="" with="" follow-up="">2 xyoo raug tshem tawm. Kwv yees li ib nrab ntawm cov neeg tuaj koom tau muab cais ua cov lus teb zoo tshaj plaws ntawm 1 xyoos. Cov yam ntxwv ntawm cov neeg koom nrog los ntawm kev kho cov lus teb tau qhia nyob rau hauv kab lus 1.

The subset of eight or fewer predictors yielding the best prediction performance across the different models included activity, chronicity, interstitial fibrosis and interstitial inflammation scores and baseline laboratory values for urine protein-to-creatinine ratio, white blood cell count, and hemoglobin. The univariate cvAUCs for these seven variables are shown in table 2. The cvAUCs for the best models selected for each modeling approach range from 0.62 to 0.80 with the random forest model yielding the best cvAUC. Five of the eight models considered had a cvAUC >0.75 thiab suav nrog LR, RF, SVML, SVMR, thiab ANN qauv. Table 3 qhia txog cvAUCs thiab kev kwv yees subset rau tsib tus qauv nrog cvAUC siab. Table 4 qhia qhov rhiab heev thiab qhov tshwj xeeb ntawm txhua tus qauv thiab yog nyob ntawm qhov kev kwv yees nruab nrab ntawm tag nrho tsib tus qauv ntawm peb theem pib. Interstitial o yog qhov kev kwv yees zoo tshaj plaws thiab tau suav nrog tag nrho tsib tus qauv. Cov qhab nia ntawm kev ua si thiab interstitial fibrosis kuj zoo ib yam thiab tau suav nrog txhua yam tab sis tus qauv RF. Tus neeg txais kev ua haujlwm yam ntxwv (ROC) nkhaus raws li 10-fold CV kwv yees los ntawm txhua tus ntawm tsib tus qauv xaiv tau qhia hauv daim duab 1. Daim duab 2 qhia txog qhov ua tau zoo (rhiab heev thiab tshwj xeeb) ntawm qhov nruab nrab ntawm txhua tus qauv raws li nyob rau ntawm qhov kev twv ua ntej pib xaiv. Cov qauv CART, SVMP, thiab NB txhua tus muaj cvAUCs<0.7 and="" were="" excluded="" from="" further="">

Siv xya qhov sib txawv tshaj plaws, daim ntawv thov web-based tau tsim nrog R ci ci los ua cov cuab yeej kho mob thiab tuaj yeem pom ntawm no: (https://histologyapp. shinyapps.io/LN_histology{{2 }}kev twv ua ntej_tool/). Hauv daim ntawv thov, ib qho piv txwv ntawm tus neeg mob cov ntaub ntawv raug tso tawm los ntawm lub neej ntawd. Txhawm rau ntsuas tus neeg mob tshiab, cov neeg siv tuaj yeem nkag mus rau hauv histology thiab cov chaw kuaj mob qhov tseem ceeb tau txais thaum lub sijhawm kuaj ntshav. Cov txiaj ntsig tau piav qhia, raws li cov xim xim, qhov kev kwv yees qhov tshwm sim ntawm qhov tsis teb ntawm txhua tus qauv ntawm qhov pib ntawm 0.5. Qhov luaj li cas ntawm txhua lub dot qhia txog ROC AUC nyob rau hauv cov txheej txheem validation. Lub thawv ntawv ntawm nplooj ntawv nthuav dav sawv cev rau qhov nruab nrab (kab), IQR (lub thawv), thiab 25th thiab 75 feem pua ​​​​± 1.5 npaug ntawm IQR (whiskers) ntawm cov qhab nia qhov tshwm sim rau cov lus teb tsis zoo hauv cov neeg mob hauv cov neeg teb thiab cov neeg tsis teb. nyob rau hauv cov validation teev (tseem qhia nyob rau hauv daim duab 2A). Txhua xim dot sawv cev rau ib qho qauv kev kwv yees ntawm tus neeg mob tau pom nyob rau hauv cov ntsiab lus ntawm kev ua tau zoo ntawm tus qauv hauv cov txheej txheem validation. Cov dub 'X' sawv cev rau qhov kev kwv yees qhov tshwm sim ntawm qhov tsis teb ntawm tag nrho tsib tus qauv.

Kev sib tham

Peb txoj kev tshawb fawb tau txiav txim siab tias kev kawm tshuab tuaj yeem siv los tsim cov qauv sib txawv nrog kev kwv yees zoo ntawm cov lus teb tsis zoo rau kev kho mob hauv cov neeg mob LN, feem ntau ntawm cov neeg African qhovntsej thiaj tsis mob. Cov qauv no tau tsim los siv cov chaw kuaj mob yooj yim thiab cov ntsiab lus histopathological thaum lub sijhawm kuaj mob. Kev siv hluav taws xob ntawm tus kheej cov yam ntxwv histopathological los kwv yees cov txiaj ntsig hauv kev nthuav dav lupus nephritis tau piav qhia zoo. Cov hauj lwm yav dhau los tau ua kom pom qhov kev kwv yees lub zog ntawm kev sib xyaw ua haujlwm Performance index qhab nia hauv kev ua rau lub raum tsis ua haujlwm, nrog rau tus kheej cov yam ntxwv ntawm kev ua haujlwm xws li cellular crescents thiab fibrinoid necrosis uas qhia txog kev sib raug zoo nrog rau lub raum tsis ua haujlwm.15 Qhov sib xyaw ntawm lub raum tsis ua haujlwm raws li tus kheej cov yam ntxwv xws li Raws li interstitial fibrosis, glomerular sclerosis, thiab fibrous crescents kuj tau kwv yees, nrog tubular atrophic kev hloov pauv tau txiav txim siab tias muaj txiaj ntsig tshwj xeeb rau kev ua rau lub raum tsis ua haujlwm.15 Ntxiv rau cov ntaub ntawv kho mob, tshwj xeeb yog cov ntshav creatinine, hematocrit, thiab haiv neeg. rau cov yam ntxwv histological txhim kho kev kwv yees hauv kev ua haujlwm tom ntej, thaum lwm qhov kev tshawb fawb pom ntawm kev siv cov kev ua haujlwm ib leeg lossis cov ntsuas ntsuas ntev tsis txaus hauv kev kwv yees cov lus teb. 16–19 Cov txheej txheem kev kawm tshuab tsis ntev los no tau siv ntau txoj kab rov qab thiab kev sim hav zoov random los kwv yees kev faib cov kab mob, kev ua ub no, thiab kev mob ntev los ntawm qhov chaw kuaj mob muaj txiaj ntsig thiab tau pom muaj kev cog lus. 1 xyoo.

zaj tshuaj ntsuab cistanche rau lub raum

As demonstrated in previous studies, the addition of novel biomarkers obtained at the time of diagnosis can be used to develop a robust model to predict the 1-year outcome.21 However, no measures of these novel biomarkers are in clinical use. In this study, readily available histological and clinical laboratory values were used to predict LN outcomes with a ROC AUC of >0.75 hauv tsib qauv. Txoj kev tshawb no yog qhov tshwj xeeb hauv cov haujlwm ntawm tus kheej thiab cov qhab nia ntev tau siv rau hauv cov qauv kev kawm tshuab. Qhov no yog kev txhawb nqa los ntawm cov ntaub ntawv ua ntej piav txog lawv cov kev siv tus kheej.15

Cov txiaj ntsig ntawm qhov kev kwv yees qauv no yuav tsum tau txhais hauv cov ntsiab lus kho mob kom raug. Lub xub ntiag ntawm siab interstitial fibrosis nrog cov qhab nia qis qis yog qhov qhia tau tias muaj kev raug mob ntev uas yuav siv tshuaj tiv thaiv kab mob los tiv thaiv kev ua phem ntxiv es tsis ua kom lub raum ua haujlwm. Txawm li cas los xij, cov neeg uas muaj cov qhab-nees ua haujlwm siab yuav raug mus nrog kev kho cov tshuaj tiv thaiv kab mob sib xyaw ua ke los yog saib xyuas ntxiv rau kev kho mob thib ob sai dua los txhim kho lossis khaws lub raum ua haujlwm. Muab hais tias cov ntaub ntawv no tau rov qab los, peb tsis paub seb puas siv cov kev kwv yees los coj kev txiav txim siab ntawm kev kho induction yuav hloov cov txiaj ntsig. Raws li feem ntau hauv kev tswj hwm cov neeg mob uas muaj kab mob autoimmune, nws yuav tsis tsim nyog rau tus kws kho mob txiav txim siab txog kev xaiv kev kho mob raws li qhov kev kwv yees no yam tsis xav txog cov ntsiab lus kho mob. Txawm li cas los xij, kev kwv yees ntawm qhov tsis teb yuav raug siv los hloov qhov zaus ntawm kev saib xyuas cov lus teb thiab kev saib xyuas kev sib koom tes kom ntseeg tau tias kev ua raws li kev noj tshuaj.

Nws kuj tseem tuaj yeem txiav txim siab hauv kev txiav txim siab ntxiv lossis hloov kho rau qhov tsis muaj lus teb ntawm lub sijhawm ua ntej cov ntsiab lus tshaj li qhov pom zoo 6 lub hlis raws li ACR cov lus qhia.

Txoj kev tshawb no muaj ntau yam kev txwv. Cov ntaub ntawv siv los ua qauv tau tshwm sim feem ntau yog los ntawm cov neeg mob ntawm African qhovntsej thiaj tsis mob. Yog li, kev siv hauv kev kho mob yuav raug txwv rau cov pej xeem no. Thaum cov ntaub ntawv longitudinal nyob rau hauv txoj kev tshawb no tau sau yav tom ntej, kev tsom xam yog rov qab. Thaum thrombotic microangiopathy tau cuam tshuam nrog cov txiaj ntsig hauv kev tshawb fawb ua ntej, 22 tus naj npawb ntawm biopsies nrog qhov kev tshawb pom no (tsib) txwv nws qhov tseem ceeb hauv cov qauv. Cov kev pab txiav txim siab uas tau nthuav tawm ntawm no tsis tau siv yav tom ntej los txiav txim siab yog tias hloov kho cov tswv yim kho raws li cov qhab nia twv ua ntej txhim kho cov txiaj ntsig. Nws tsis tau raug ntsuas nyob rau hauv qhov kev kwv yees ntawm cov txiaj ntsig mus ntev thiab yuav tsum tsis txhob siv los kwv yees > 1-cov txiaj ntsig xyoo. Txawm li cas los xij, 1-cov txiaj ntsig xyoo tau cuam tshuam nrog cov txiaj ntsig mus ntev hauv MAINTAIN thiab Euro-Lupus Nephritis Trials.8 Kev xaiv cov neeg mob rau kev koom nrog hauv txoj kev tshawb no tuaj yeem ua rau cov txiaj ntsig tsis zoo. Piv txwv li, cov neeg uas muaj kab mob hauv lub raum sai dua tuaj yeem tau txais kev kuaj mob biopsy. Cov uas muaj cov hauv paus ntsiab lus thiab kwv yees li ntawm 1- xyoo tom qab muaj nyob rau hauv cov ntaub ntawv kho mob tej zaum yuav muaj kev cuam tshuam rau cov txiaj ntsig zoo dua. Peb tsis tuaj yeem kawm nruj me ntsis txog cov txiaj ntsig ntawm cov tshuaj ntawm cov txiaj ntsig, vim tias cov neeg mob feem ntau tau txais mycophenolate lossis mycophenolic acid.

Muab qhov heterogeneity ntawm kev nthuav qhia kab mob hauv LN, nws yog ib qho tseem ceeb uas cov qauv kev pheej hmoo yuav suav nrog ntau cov ntaub ntawv. Daim ntawv tshaj tawm no muab thawj zaug cov cuab yeej kho mob uas siv tsib tus qauv kev kwv yees ntau tshaj plaws thiab ua kom yooj yim rau kev nkag siab ntawm lawv los ntawm kev siv lub vev xaib. Nrog rau cov qauv kev twv ua ntej tau hais tawm ntawm no, peb nthuav tawm cov ntaub ntawv pov thawj ntawm lub tswv yim rau lub cuab yeej uas tuaj yeem qhia ob qho tib si ntawm kev saib xyuas thiab pab txhawb kev sib tham nrog cov neeg mob txog kev xaiv kev kho mob. Kev saib xyuas kom zoo dua lossis siv kev sib koom tes saib xyuas rau cov neeg uas tau kwv yees kom muaj cov lus teb tsis zoo rau kev kho mob muaj peev xwm txhim kho cov txiaj ntsig tab sis yuav tsum tau sim yav tom ntej.

acteosidehauvcistanchemuaj cov teebmeem zoo rauraum

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