摘要
目的分析影响IgA肾病患者预后的危险因素,构建并评价IgA肾病患者预后风险预测模型。方法收集2017年10月-2022年10月北京市昌平区中西医结合医院肾病科经肾活检确诊的452例IgA肾病患者的临床资料,通过采集临床资料、实验室指标、病理指标、中医证候及其要素等,以初始血肌酐(SCr)较基线水平增倍或初始估算肾小球滤过率(eGFR)较基线降低超过50%,或进入终末期肾病(ESRD)期为联合终点事件指标,Cox单因素和多因素回归分析筛选影响IgA肾病预后的危险因素,应用R4.1.1构建列线图模型,评估模型的预测水平和区分度。结果根据Cox多因素回归分析结果,最终纳入24h尿蛋白定量、时间平均尿蛋白定量(TA-UP)、新牛津病理分型T评分、新牛津病理分型C评分、气阴两虚5个因子。根据上述预测因子建立预后风险预测模型,结果显示其一致性指数为0.810(95%CI:0.673~0.815,P<0.001)。校正曲线显示模型拟合度较好;3年受试者工作特征曲线下面积为0.757(95%CI:0.739~0.823),表明该模型的预测概率较好。结论基于中医证候学的IgA肾病列线图模型能较准确地预测IgA肾病患者预后风险,可为临床预测IgA肾病风险提供参考依据。
Objective To analyze the risk factors affecting the prognosis of IgA nephropathy patients;To construct and evaluate the prognosis risk prediction model of IgA nephropathy patients.Methods From October 2017 to October 2022,the clinical data of 452 patients with IgA nephropathy diagnosed by renal biopsy in the Department of Nephrology,Beijing Changping District Hospital of Integrated Traditional Chinese and Western Medicine were collected.Through the collection of clinical data,laboratory indicators,pathological indicators,and TCM syndromes,based on the doubling of the initial SCr compared with the baseline level or the reduction of the initial eGFR by more than 50%compared with the baseline,or entering the ESRD period as the combined endpoint event indicators,the risk factors affecting the prognosis of IgA nephropathy were screened.Cox univariate and multivariate regression analysis were used to screen for risk factors affecting the prognosis of IgA nephropathy.A nomogram model was constructed using R 4.1.1 to evaluate the predictive level and discrimination of the model.Results According to the results of multivariate Cox regression analysis,5 predictive factors were finally included:24 h urine protein quantification,TA-UP,New Oxford Pathological Classification T score,New Oxford Pathological Classification C score,deficiency of both qi and yin.A prognostic risk prediction model was established based on the above predictive factors,and the results showed that the consistency index was 0.810(95%CI:0.673-0.815,P<0.001).The calibration curve showed a good fit of the model;the area under the ROC curve for 3 years was 0.757(95%CI:0.739-0.823),indicating that the prediction probability of the model was good.Conclusion The nomogram model of IgA nephropathy based on TCM syndrome can predict the prognosis risk of IgA nephropathy patients more accurately,and can provide a reference for clinical prediction of IgA nephropathy risk.
作者
史彬
司远
SHI Bin;SI Yuan(Beijing Changping District Hospital of Integrated Traditional Chinese and Western Medicine,Beijing 102208,China;The Gu Lou Hospital of Traditional Chinese Medicine of Beijing,Beijing 100009,China)
出处
《中国中医药信息杂志》
CAS
CSCD
2024年第5期131-137,共7页
Chinese Journal of Information on Traditional Chinese Medicine
基金
国家重点研发计划(2019YFC17085-03)。
作者简介
通讯作者:司远,E-mail:siyuan728@163.com。
