nell-1阳性的膜性肾病患者病理特点及预后分析

Analysis of pathological characteristics and prognosis of patients with nell-1 positive membranous nephropathy

目的探讨神经表皮生长因子样蛋白1(nell-1)阳性的膜性肾病患者病理特点及预后。方法选择2020年1月-2022年3月我院收治的183例膜性肾病患者,经肾小球免疫组化共筛选出60例M型磷脂酶A2受体(PLA2R)阴性患者作为研究对象,检测患者肾小球中nell-1表达情况,并将患者分为nell-1阴性组和nell-1阳性组。比较两组患者的临床特点;Kaplan-Meier法绘制生存曲线,比较两组患者累积肾脏生存率和累积尿蛋白缓解率;单因素及多因素Cox回归分析影响患者肾脏复合终点及尿蛋白未缓解的因素;构建列线图预测模型并评价其区分度、准确性和有效性。结果60例患者肾小球nell-1阳性率为35.00%(21/60);nell-1阳性与患者年龄、水肿、超大量尿蛋白、血清BUN、SUA、肾小球滤过率(eGFR)有关(P<0.05);nell-1阴性组累积肾脏生存率和累积尿蛋白缓解率均明显高于nell-1阳性组(P<0.05);年龄增加、超大量尿蛋白、电镜亚型为异质型、nell-1阳性是影响患者肾脏复合终点的危险因素(P<0.05);年龄增加、高血压、肾病综合征、超大量尿蛋白、病理分期Ⅱ~Ⅴ期、补体3(C3)沉积、电镜亚型为异质型、肾小管间质病变、nell-1阳性是影响患者尿蛋白未缓解的危险因素(P<0.05);列线图模型的区分度较高,准确性和有效性较好。结论nell-1阳性与膜性肾病患者临床病理特点有关,且患者的累积肾脏生存率和尿蛋白缓解率较低。

Objective To investigate the pathological characteristics and prognosis of patients with membranous nephropathy with positive neural epidermal growth factor-like 1 protein(nell-1).Methods A total of 183 patients with membranous nephropathy admitted to our hospital from January 2020 to March 2022 were selected.60 patients with negative M-type phospholipase A2 receptor(PLA2R)were selected as the study subjects through glomerular immunohistochemistry.The expression of nell-1 in the glomeruli of the patients was detected,and the patients were divided into nell-1 negative group and nell-1 positive group.The clinical characteristics of the two groups were compared.The cumulative renal survival rate and cumulative urinary protein remission rate were compared between the two groups by Kaplan-Meier method.Univariate and multivariate Cox regression analysis was used to analyze the factors affecting the renal complex end point and the unremission of urinary protein.Construct the line chart prediction model and evaluate its differentiation,accuracy and effectiveness.Results The positive rate of glomerular nell-1 in 60 patients was 35.00%(21/60).The positive rate of nell-1 was related to age,edema,excessive proteinuria,serum BUN,SUA and eGFR(P<0.05).The cumulative renal survival rate and cumulative urinary protein remission rate in nell-1 negative group were significantly higher than those in nell-1 positive group(P<0.05).Age,excessive proteinuria,heterogeneity of electron microscopic subtypes and positive nell-1 were the risk factors of renal complex end point(P<0.05).Age,hypertension,nephrotic syndrome,excessive proteinuria,pathological stageⅡ~Ⅴ,C3 deposition,electron microscopic subtype heterogeneity,renal tubulointerstitial lesions and positive nell-1 were the risk factors of urinary protein unremission(P<0.05).The discrimination degree of the line chart model is high,and the accuracy and validity are good.Conclusion The positive rate of nell-1 is related to the clinicopathological characteristics of patients with membranous nephropathy,and the cumulative renal survival rate and urinary protein remission rate of patients are low.