特发性膜性肾病患者急性肾小管损伤的相关因素分析

Analysis of factors associated with concurrent acute renal tubular injury in idiopathic membranous nephropathy patients

目的探讨广西多民族聚居地区特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者急性肾小管损伤的相关因素。方法纳入2013年4月至2021年11月在河池市人民医院住院经肾活检确诊为IMN的患者,分为不伴急性肾小管损伤(n=112)和伴急性肾小管损伤(n=43)组。结果多因素Logistic分析提示,血清β2微球蛋白(Beta-2 microglobulin,β2-MG)与IMN患者急性肾小管损伤独立相关(OR=1.06,95%CI:1.01~1.12,P=0.014)。受试者工作特征曲线分析,血清β2-MG诊断IMN患者发生急性肾小管损伤的曲线下面积值为0.748,最佳临界值为2.65mg/L,对应的灵敏度为81.4%,特异度为58.04%。按照血清β2-MG浓度分为低、中、高3组。与低组相比,中组、高组患者肾小管损伤发生风险分别增加5.01倍、22.89倍,趋势检验结果显示,随着血清β2-MG浓度增加,IMN患者发生急性肾小管损伤的风险亦增加(P<0.001)。分层交互检验分析提示,在性别、不同低蛋白血症程度、民族中血清β2-MG与IMN患者急性肾小管损伤存在交互作用(P<0.05)。结论血清β2-MG与IMN患者急性肾小管损伤独立相关,在性别、不同低蛋白血症程度、民族中存在交互作用。

Objective To explore the influencing factors the combination of acute renal tubular injury(ARTI) in patients with idiopathic membranous nephropathy(IMN) in a multi-ethnic area of Guangxi.Methods From April 2013 to October 2021,155 patients with IMN diagnosed by renal biopsy and hospitalized at Hechi People's Hospital were recruited.They were assigned into two groups of with ARTI(n = 43) and without(n = 112).Results Multifactorial Logistic analysis revealed that serum β2microglobulin(β2-MG) was independently associated with ARTI in IMN patients(OR = 1.06,95%CI:1.01 to 1.12,P = 0.014).AUC value for ROC curve analysis of serum β2 microglobulin for diagnosing ARTI was 0.748.An optimal threshold value of 2.65 mg/L corresponded to a sensitivity of 81.4% and a specificity of 58.04%.According to serum β2 microglobulin level,they were assigned into three groups of low,medium and high.The odds of ARTI spiked 5.01 and 22.89 folds in medium and high groups as compared with low group.And the results of trend test indicated that the odds of ARTI in IMN patients increased with a rising serum β2 microglobulin concentration(P<0.001).Stratified interaction test analysis revealed an interaction between serum β2 microglobulin and ARTI in IMN patients among gender,differential degrees of hypoproteinemia and ethnicity(P for interaction <0.05).Conclusion Serum β2 microglobulin is independently associated with ARTI in IMN patients.And an interaction exists between gender,differential levels of hypoproteinemia and ethnicity.