抗中性粒细胞胞质抗体肾脏风险评分在儿童抗中性粒细胞胞质抗体相关性肾小球肾炎中的应用

The application of antineutrophil cytoplasmic antibody renal risk score in children with antineutrophil cytoplasmic antibody-associated glomerulonephritis

目的探讨抗中性粒细胞胞质抗体(ANCA)肾脏风险评分(ARRS)对儿童ANCA相关性肾小球肾炎(AAGN)预后的预测价值。方法回顾性分析2007年6月至2022年5月东部战区总医院经肾穿刺活检确诊为AAGN的61例患儿的实验室检查和肾脏病理结果、治疗方法和预后等资料。采用Kaplan-Meier法评估AAGN儿童的总体和肾脏存活率,采用Cox回归模型分析进展为终末期肾病(ESRD)的风险因素。结果61例AAGN患儿中男14例,女47例;年龄(15.65±3.74)岁。根据ARRS将AAGN儿童分为3组:低风险组(27例)、中等风险组(21例)和高风险组(13例)。经过46.36(14.58,95.62)个月的随访,高风险组(9例)进展为ESRD例数高于低风险组(2例)和中风险组(3例)(χ^(2)=13.079,P<0.001)。Kaplan-Meier生存分析显示,高风险组肾脏预后最差(χ^(2)=5.796,P=0.016),3组总体生存率差异无统计学意义(χ^(2)=2.883,P=0.237)。多因素Cox回归分析结果表明,估算肾小球滤过率(eGFR)≤15 mL/(min·1.73 m^(2))(HR=9.574,95%CI:4.205~25.187,P=0.015)和ARRS(HR=2.115,95%CI:1.206~4.174,P=0.012)是AAGN患儿进展为ESRD的独立危险因素。受试者工作特征(ROC)曲线结果显示,ARRS预测AAGN儿童进展为ESRD风险的ROC曲线下面积为0.880(95%CI:0.759~1.000),其最佳截断值为5.50,敏感度和特异度分别为85.71%和82.98%。结论ARRS是AAGN儿童进展为ESRD的独立危险因素,对儿童AAGN进展为ESRD具有预测价值。

Objective To investigate the potential of the antineutrophil cytoplasmic antibody(ANCA)renal risk score(ARRS)in predicting the prognosis of children with ANCA-associated glomerulonephritis(AAGN).Methods Laboratory testing,renal pathology results,treatment and prognosis of 61 children with AAGN diagnosed by renal biopsy from June 2007 to May 2022 in General Hospital of Eastern Theater Command were retrospectively analyzed.The Kaplan-Meier method was used to evaluate the overall and renal survival of children with AAGN,and risk factors of progression to end stage renal disease(ESRD)were analyzed by Cox regression analysis.Results Among the 61 children with AAGN,there were 14 males and 47 females with the age of(15.65±3.74)years.According to ARRS,AAGN children were assigned into low-risk group(27 cases),medium-risk group(21 cases)and high-risk group(13 cases).During a median follow-up duration of 46.36(14.58,95.62)months,the number of ESRD cases in the high-risk group(9 cases)was significantly higher than that of low-risk group(2 cases)and medium-risk group(3 cases)(χ^(2)=13.079,P<0.001).Kaplan-Meier survival analysis showed that AAGN children in the high-risk group had the worst renal prognosis(χ^(2)=5.796,P=0.016),while no significant difference was detected in the overall survival among the 3 groups(χ^(2)=2.883,P=0.237).Multivariate Cox regression showed that estimate glomerular filtration rate(eGFR)≤15 mL/(min·1.73 m^(2))(HR=9.574,95%CI:4.205-25.187,P=0.015)and ARRS(HR=2.115,95%CI:1.206-4.174,P=0.012)were independent risk factors for children with AAGN progress to ESRD.Receiver operating characteristic(ROC)curve analysis results showed that the area under the curve of ARRS for predicting the risk of progressing to ESRD in AAGN children was 0.880(95%CI:0.759-1.000),and the optimal cutoff value of ARRS was 5.50,with the sensitivity and specificity of 85.71%and 82.98%,respectively.Conclusions ARRS was an independent risk factor for children with AAGN progress to ESRD,which had a predictive value for the progression of AAGN to ESRD.