NPR预测ANCA相关血管炎不良肾脏预后及其协同多因素优化模型

doi:10.6040/j.issn.1671-7554.0.2023.1044

摘要/Abstract

摘要： 目的本研究旨在探讨中性粒细胞血小板比值(neutrophil-to-platelet ratio, NPR)与抗中性粒细胞胞浆抗体(anti-neutrophil cytoplasmic antibody, ANCA)相关血管炎(ANCA-associated vasculitis, AAV)肾损害患者1年肾脏预后的关系,寻找评估1年肾脏预后的NPR截断值,并将NPR纳入1年肾脏预后分析中,联合多因素构建高效能的预后预测模型。方法回顾性分析2010年1月至2021年11月山东大学齐鲁医院收治的258例AAV肾损害患者。分析NPR水平与诊断时实验室指标以及1年肾脏替代治疗(renal replacement therapy, RRT)率之间的关系,构建ROC曲线,计算NPR截断值,按照NPR水平将患者分为高NPR组(n=41例)和低NPR组(n=82例)。采用Mann-Whitney U检验和卡方检验分析两组数据差异。构建二元Logistic回归模型,分析NPR与1年肾脏替代治疗率的关系,纳入NPR联合多因素建立1年肾脏预后预测模型。结果高NPR组男22例(53.7%),女19例(46.3%);低NPR组男46例(56.1%),女36例(43.9%)。24例(19.5%)肾脏受累患者1年内进入RRT。对其进行单因素和多因素二元Logistic回归分析,将单因素分析有意义的指标纳入多因素分析。本研究中较高的伯明翰血管炎活动评分(Birmingham vasculitis activity score, BVAS)(OR=1.272,95%CI:1.034~1.567,P=0.023)、较高的肌酐(serum creatinine, SCR)水平(OR=1.008,95%CI:1.004~1.012, P<0.001)以及较高的NPR(OR=4.931,95%CI:1.153~21.091, P=0.031)是患者1年内进入RRT的预测因素。NPR>0.033 2是AAV肾损害患者1年内进入RRT的独立预测因素。NPR联合多因素的二元Logistic回归模型预测1年RRT率效果好,ROC曲线下面积为0.960(95%CI:0.889~0.997,P<0.001)。结论 NPR 是一种便利且成本低廉的炎症指标,NPR>0.033 2的患者更易在初诊1年内进入终末期肾脏病(end-stage renal disease, ESRD)并接受RRT。本研究构建的包括BVAS、血红蛋白、白蛋白、SCR、NPR指标在内的1年肾脏预后预测模型预测性能较好。

关键词: 抗中性粒细胞胞浆抗体, 血管炎, 中性粒细胞血小板比值, 肾脏预后, 预测模型构建

Abstract: Objective To explore the relationship between neutrophil-to-platelet ratio(NPR)and the first-year renal prognosis in patients with renal damage caused by anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV), so as to find the cut-off value of NPR for assessing first-year renal prognosis, and to construct a high-performance prognostic prediction model. Methods Clinical data of 258 patients with renal damage caused by AAV who were admitted to Qilu Hospital of Shandong University during Jan. 2010 and Nov. 2021 were retrospectively analyzed. The relationship between NPR and laboratory indicators at diagnosis as well as the first-year renal replacement therapy(RRT)rate was analyzed. Receiver operating characteristic curve was plotted to calculate the cut-off value of NPR. After that, patients were classified into high NPR group(n=41)and low NPR group(n=82). Mann-Whitney U test and chi-square test were used to analyze the differences between the two groups. The relationship between NPR and first-year RRT rate was analyzed by constructing a binary Logistic regression model. The first-year renal prognosis prediction model was established with NPR and other factors. Results There were 22 male(53.7%)and 19 female(46.3%)in the high NPR group, and 46 male(56.1%)and 36 female(43.9%)in the low NPR group. Altogether 24 patients(19.5%)underwent RRT within the first year. Univariate and multivariate binary Logistic regression analysis were performed, and significant variables in univariate analysis were included in multivariate analysis. High level of Birmingham vasculitis activity score(BVAS)(OR=1.272, 95%CI:1.034-1.567, P=0.023), high level of serum creatinine(SCR)(OR=1.008, 95%CI:1.004-1.012, P<0.001), and high level of NPR(OR=4.931, 95%CI:1.153-21.091, P=0.031)were predictors of RRT within the first year. NPR>0.033 2 was an independent predictor of RRT. The binary Logistic regression model of NPR combined with multifactor functioned well in predicting the first-year RRT rate, with an area under the curve(AUC)of 0.960(95%CI:0.889-0.997, P<0.001). Conclusion NPR is a convenient and cost-effective inflammation indicator. Patients with NPR >0.033 2 are more likely to enter end-stage renal disease(ESRD)and undergo RRT within the first year after initial diagnosis. The first-year renal prognostic prediction model constructed in this study, including BVAS, hemoglobin, albumin, SCR and NPR, has a good predictive performance.

Key words: Anti-neutrophil cytoplasmic antibody, Vasculitis, Neutrophil-to-platelet ratio, Renal prognosis, Construction of predictive model

中图分类号:

R692

刁玉洁,林琳,李文瑄,王洲洋,江蓓,胡迎迎,刘广义. NPR预测ANCA相关血管炎不良肾脏预后及其协同多因素优化模型[J]. 山东大学学报 (医学版), 2024, 62(2): 60-68.

DIAO Yujie, LIN Lin, LI Wenxuan, WANG Zhouyang, JIANG Bei, HU Yingying, LIU Guangyi. Neutrophil-to-platelet ratio predicts adverse renal outcomes in anti-neutrophil cytoplasmic antibody-associated vasculitis and its synergistic multifactor optimization model[J]. Journal of Shandong University (Health Sciences), 2024, 62(2): 60-68.

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