目的: 探讨抗M型磷脂酶A2受体（anti-M-type phospholipase a 2 receptor,PLA2R）抗体在原发性膜性肾病（primary membranous nephropathy,PMN）患者治疗后1年疾病缓解的预测价值。方法: 纳入2020年1月—2023年1月于我院接受治疗的106例PMN患者,依据治疗后1年疾病是否缓解,分为缓解组72例,未缓解组34例;对比两组临床资料,采用Logistic回归分析明确PMN患者治疗后未缓解的独立影响因素,并绘制受试者工作特征（ROC）曲线分析抗PLA2R抗体对PMN患者治疗后未缓解的预测价值。将获得的独立影响因素纳入构建列线图预测模型,采用R软件中C指数、ROC曲线及校准曲线评价PMN患者治疗后未缓解的列线图模型效能。结果: 两组临床资料对比中,缓解组的年龄、24小时尿总蛋白定量（24-hour urine total protein quantification,24 hUP）、抗PLA2R抗体低于未缓解组,缓解组的肾小球滤过率（estimated glomerular filtration rate,eGFR）、白蛋白（albumin,ALB）高于未缓解组,差异具有统计学意义;其余临床资料对比无差异。在PMN患者治疗1年后,经卡方检验Phi系数、Kendall's tau-b相关性分析结果显示,抗PLA2R抗体与24 hUP呈正相关（r>0,P<0.05）,与eGFR和ALB呈负相关（r<0,P<0.05）。经Logistic回归分析结果显示,和抗PLA2R抗体水平高、白蛋白（albumin,ALB）水平低均是PMN患者治疗1年后未缓解的独立危险因素。绘制ROC曲线,结果显示抗PLA2R抗体水平的AUC值为0.957,说明抗PLA2R抗体对PMN患者治疗1年后是否缓解具有很好的预测价值。构建预测PMN患者治疗1年后未缓解的列线图模型,经验证结果显示,校准曲线C-index值为0.950,ROC曲线建模组的AUC为0.950,验证组的AUC为0.969,说明该列线图模型具有良好的预测能效和判别能力。结论: 抗PLA2R抗体水平与24hUP、ALB相关;抗PLA2R抗体是影响PMN患者治疗后是否缓解的独立因素,抗PLA2R抗体水平越高,PMN患者疗效越差。
Abstract
Objective To explore the predictive value of anti-M-phospholipase A2 receptor (PLA2R) antibody in the remission of primary membranous nephropathy (PMN) patients one year after treatment. Methods One hundred and six patients with PMN treated in our hospital from January 2020 to January 2023 were divided into remission group (72 cases) and non-remission group (34 cases) according to whether the disease was relieved one year after treatment. The clinical data of the two groups were compared, and the correlation between anti-PLA2R antibody and non-remission of PMN patients after treatment was analyzed. Logistic regression analysis was used to identify the independent influencing factors of non-remission of PMN patients after treatment, and the ROC curve of subjects was drawn to analyze the predictive value of anti-PLA2R antibody for non-remission of PMN patients after treatment. The independent influencing factors obtained were incorporated into the nomogram prediction model, and the effectiveness of the nomogram model was evaluated by C index, ROC curve and calibration curve in R software. Results Compared with the clinical data of the two groups, the age, 24hUP and anti-PLA2R antibody in remission group were lower than those in non-remission group, while eGFR and ALB in remission group were higher than those in non-remission group, with statistical significance. There was no difference in other clinical data. After one year’s treatment of PMN patients, Chi-square test and Kendall’s tau-b correlation analysis showed that anti-PLA2R antibody was positively correlated with 24-hour UP and negatively correlated with eGFR and ALB. Logistic regression analysis showed that high level of 24-hour UP and anti-PLA2R antibody and low level of ALB were independent risk factors for PMN patients who were not relieved after one year of treatment. The ROC curve was drawn, and the result showed that the AUC value of anti-PLA2R antibody level was 0.957, which indicated that anti-PLA2R antibody had a good predictive value for the remission of PMN patients after one year of treatment. A nomogram model was constructed to predict the unresponsiveness of PMN patients after one year of treatment. The verified results showed that the C-index value of the calibration curve was 0.950, the AUC of the ROC curve modeling group was 0.950, and the AUC of the verification group was 0.969, which indicated that the nomogram model had good predictive energy efficiency and discriminating ability. Conclusion The level of anti-PLA2R antibody is related to 24-hour UP and ALB. Anti-PLA2R antibody is an independent factor that affects the remission of PMN patients after treatment. The higher the level of anti-PLA2R antibody, the worse the prognosis of PMN patients.
关键词
抗M型磷脂酶A2受体抗体 /
原发性膜性肾病 /
预后 /
列线图模型
Key words
anti-M-type phospholipase a 2 receptor /
primary membranous nephropathy /
prognosis /
nomogram model
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基金
2020年度河北省医学科研课题计划“尿酸血症与冠状动脉粥样硬化性心脏病相关性研究”（202001844）
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