IgA肾病患者血浆FⅧ水平对不良预后的预测价值

Predictive value of plasma FⅧ level in adverse prognosis in patients with IgA nephropathy

目的分析血浆凝血因子VⅢ(FⅧ)对IgA肾病患者不良预后的预测价值。方法回顾性收集2017年4月至2018年5月就诊于沧州市中心医院的原发性IgAN患者共84例,收集所有研究对象的临床资料,包括一般情况(年龄、性别、病史、体质指数、血压)、24h尿蛋白量及血生化指标等,随后进行为期3年的随访。利用Spearman相关法分析血浆FⅧ水平与临床指标的相关性。采用单因素Cox回归分析建立模型并计算风险比值(HR),多因素Cox回归分析进行矫正,明确独立危险因素。采用ROC曲线分析检验不同指标的预测效能并进行比较。结果血浆FⅧ水平与年龄、eGFR下降速率、尿蛋白定量、收缩压、血肌酐、血浆纤维蛋白原、血总胆固醇、血三酰甘油、D-二聚体等指标均呈正相关;中位随访时间为38.19(36.32,40.56)个月,共10例患者(13.10%)发生不良预后。单因素Cox回归分析显示,FⅧ水平是IgAN患者发生不良预后的危险因素。进一步利用多因素Cox回归分析进行矫正,排除收缩压、尿蛋白、eGFR、间质纤维化/肾小管萎缩程度等因素后,血浆FⅧ水平仍是发生不良预后的独立危险因素,高FⅧ水平患者不良预后发生率是低FⅧ水平患者的4.241倍;ROC曲线分析结果显示血浆FⅧ水平的AUC高于血肌酐和收缩压,但低于肾小管萎缩/间质纤维化程度;通过联合预测分析,结果显示血浆FⅧ水平与上述指标联合均可有效提高预测效能,其中联合肾小管萎缩/间质纤维化程度的AUC最高。结论在IgAN患者中,血浆FⅧ水平与临床指标密切相关,且高FⅧ水平是发生不良预后的独立危险因素,通过联合病理检查结果能够及时有效预测患者预后,对指导临床干预具有积极意义。

Objective To analyze the predictive value of plasma coagulation factor VⅢ(FⅧ)in adverse prognosis of patients with IgA nephropathy.Methods A total of 84patients with primary IgAN admitted to Cangzhou Central Hospital from April 2017to May 2018were retrospectively collected.Clinical data of all subjects were collected,including general conditions(age,sex,medical history,body mass index,blood pressure),24hurinary protein volume and blood biochemical indexes,etc.,followed by a 3-year follow-up.Spearman correlation method was used to analyze the correlation between plasma FⅧ level and clinical indexes.Univariate Cox regression analysis was used to establish the model and calculate the risk ratio(HR),and multivariate Cox regression analysis was used to correct the independent risk factors.ROC curve analysis was used to test the prediction efficiency of different indexes and compare them.Results The plasma FⅧ level was positively correlated with age,EGFR decline rate,urinary protein level,systolic blood pressure,serum creatinine,plasma fibrinogen,total cholesterol,triacylglycerol,D-dimer and other indexes.The median follow-up time was 38.19(36.32,40.56)months,and a total of 10patients(13.10%)developed poor prognosis.Univariate Cox regression analysis showed that FⅧ level was a risk factor for poor prognosis in IGAN patients.Multivariate Cox regression analysis was further used for correction,and plasma FⅧ level was still an independent risk factor for poor prognosis after the factors including systolic blood pressure,urinary protein,EGFR,and interstitial fibrosis/tubule atrophy were excluded.The incidence of poor prognosis in patients with high FⅧ level was 4.241times higher than that in patients with low FⅧ level.The results of ROC curve analysis showed that the AUC of plasma FⅧ level was higher than that of serum creatinine and systolic blood pressure,but lower than that of renal tubule atrophy/interstitial fibrosis.Combined predictive analysis showed that the combination of plasma FⅧ level and the above indexes could effectively improve the predictive efficacy,and the combination of renal tubule atrophy/interstitial fibrosis showed the highest AUC.Conclusion In patients with IGAN,plasma FⅧ level is closely related to clinical indicators,and high FⅧ level is an independent risk factor for poor prognosis.Combined with pathological examination results,the prognosis of patients can be predicted in time and effectively,which has positive significance for guiding clinical intervention.