原发性膜性肾病血栓栓塞临床预测模型的建立与验证

Establishment and Validation of a Predictive Model for Thromboembolism in Primary Membranous Nephropathy

摘要: 目的：建立原发性膜性肾病血栓栓塞预测模型并验证。方法：收集2018年8月1日~2020年12月31日于青岛大学附属医院测定抗磷脂酶A2受体抗体滴度的原发性膜性肾病病人119例，以D二聚体是否发生异常为分组依据分为血栓栓塞组(n = 39人)，非血栓栓塞组(n = 80人)。利用差异性分析与单因素逻辑回归筛选患者合并血栓栓塞并发证的危险因素。根据多因素逻辑回归分析建立血栓栓塞并发症的临床预测模型，并对临床预测模型进行评价以及验证。结果：差异性分析后，血栓栓塞组与非血栓栓塞组患者在性别、血清白蛋白、血清PLA2R抗体、24小时尿蛋白定量这4项指标有显著性差异(P < 0.05)。在单因素逻辑回归分析中上述5项均有意义是血栓栓塞的危险因素(P < 0.05)，其中经过多因素逻辑回归分析血清白蛋白与24小时尿蛋白定量可以认为是原发性膜性肾病血栓栓塞的独立危险因素(P < 0.05)。随后我们以这4项指标构建临床诊断模型并以列线图呈现。其有较好的评价性能。结论：基于性别、血清白蛋白、血清PLA2R抗体、24小时尿蛋白定量这4项指标，构建的原发性膜性肾病并发血栓栓塞的临床预测模型，对发生血栓栓塞并发症的区分度较高，有利于血栓栓塞并发症早期的防治。

Abstract: Objective: To establish and verify the prediction model of thromboembolism in primary membra-nous nephropathy. Methods: A total of 119 patients with primary membranous nephropathy, whose anti-phospholipase A2 receptor antibody titers were measured in The Affiliated Hospital of Qingdao University from August 1st, 2018 to December 31st, 2020, were divided into the thromboembolic group (n = 39) and the non-thromboembolic group (n = 80) according to the abnormality of D-dimer. Differential analysis and univariate logistic regression were used to screen the risk factors for patients with thromboembolism. The clinical prediction model of thromboembolic complications was established based on multivariate logistic regression analysis, and the clinical prediction model was evaluated and verified. Results: After difference analysis, there were significant differences in gender, serum albumin, serum PLA2R antibody and 24-hour urine protein quantification between thromboembolic group and non-thromboembolic group (P < 0.05). In univariate logistic regression analysis, all the above 4 items were significant risk factors for thromboembolism (P < 0.05), and serum albumin and 24-hour urine protein quantification could be considered as independent risk factors for thromboembolism of primary membranous nephropathy after multivariate logistic re-gression analysis (P < 0.05). Subsequently, we constructed a clinical diagnostic model based on these 4 indicators and presented it as a column chart. It has good evaluation performance. Conclu-sion: Based on the four indexes of gender, serum albumin, serum PLA2R antibody and 24-hour urine protein quantification, the clinical prediction model of primary membranous nephropathy complicated with thromboembolism was established, which has a high degree of differentiation in the occurrence of thromboembolism complications, and is conducive to the early prevention and treatment of thromboembolism complications.