New risk score for predicting progression of membranous nephropathy
New risk score for predicting progression of membranous nephropathy
复制标题
预测膜性肾病进展的新风险评分
DOI：
10.1186/s12967-019-1792-8
复制
发表时间：
2019-02-08
影响因子：
7.4
通讯作者：
Chen Nan
中科院分区：
文献类型：
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作者：
Hu Xiaofan;Xu Jing;Chen Nan
### 背景
特发性膜性肾病（IMN）患者的预后各不相同。本研究旨在构建一种工具，帮助临床医生精准预测IMN的预后。
### 方法
本研究纳入了2009年1月至2013年12月在上海瑞金医院经肾活检确诊为IMN的患者。主要终点定义为肾功能进展（定义为估算的肾小球滤过率（eGFR）较基线下降30% 及以上）、终末期肾病（ESRD）或死亡的复合终点。通过Cox比例风险回归分析建立风险模型，并采用自举重抽样分析进行验证。应用受试者工作特征（ROC）曲线检验风险评分的效能。
### 结果
本研究共纳入439例患者。中位随访时间为38.73（19.35）个月。纳入患者年龄为56（15 - 83）岁，男性居多（男女比例为1:0.91）。基线血清白蛋白、基于EPI公式估算的eGFR以及蛋白尿的中位数分别为23（8 - 43）g/L、100.31（12.81 - 155.98）ml/min/1.73m² 以及3.98（1.50 - 22.98）g/24h。共有36例患者出现主要终点事件。通过Cox回归分析，最佳风险模型纳入了年龄[风险比（HR）：1.04（1.003 - 1.08），自举法95%置信区间：1.01 - 1.08]、eGFR[HR：0.97（0.96 - 0.99），自举法95%置信区间：0.96 - 0.99]和蛋白尿[HR：1.09（1.01 - 1.18），自举法95%置信区间：1.02 - 1.16]。基于最佳模型的风险评分每增加1个单位，复合终点事件发生风险增加2.57（1.97 - 3.36）倍。该风险评分在预测复合终点事件方面具有极佳的区分度[C统计量：0.83，95%置信区间0.76 - 0.90]。
### 结论
本研究表明，肾活检时年龄较大、eGFR较低且蛋白尿较重的IMN患者发生不良预后的风险更高。基于这三个变量的风险评分可为临床医生进行风险分层提供有效工具。
BackgroundPatients with Idiopathic membranous nephropathy (IMN) have various outcomes. The aim of this study is to construct a tool for clinicians to precisely predict outcome of IMN.MethodsIMN patients diagnosed by renal biopsy from Shanghai Ruijin Hospital from 2009.01 to 2013.12 were enrolled in this study. Primary outcome was defined as a combination of renal function progression [defined as a reduction of estimated glomerular filtration rate (eGFR) equal to or over 30% comparing to baseline], ESRD or death. Risk models were established by Cox proportional hazard regression analysis and validated by bootstrap resampling analysis. ROC curve was applied to test the performance of risk score.ResultsTotally 439 patients were recruited in this study. The median follow-up time was 38.7319.35months. The enrolled patients were 56 (15-83) years old with a male predominance (sex ratio: male vs female, 1:0.91). The median baseline serum albumin, eGFR-EPI and proteinuria were 23(8-43) g/l, 100.31(12.81-155.98) ml/min/1.73m(2) and 3.98(1.50-22.98) g/24h, respectively. In total, there were 36 primary outcomes occurred. By Cox regression analysis, the best risk model included age [HR: 1.04(1.003-1.08), 95% CI from bootstrapping: 1.01-1.08), eGFR [HR: 0.97 (0.96-0.99), 95% CI from bootstrapping: 0.96-0.99) and proteinuria [HR: 1.09 (1.01-1.18), 95% CI from bootstrapping: 1.02-1.16). One unit increasing of the risk score based on the best model was associated with 2.57 (1.97-3.36) fold increased risk of combined outcome. The discrimination of this risk score was excellent in predicting combined outcome [C statistics: 0.83, 95% CI 0.76-0.90].Conclusions Our study indicated that older IMN patients with lower eGFR and heavier proteinuria at the time of renal biopsy were at a higher risk for adverse outcomes. A risk score based on these three variables provides clinicians with an effective tool for risk stratification.