摘要
目的:构建膜性肾病(MN)患者免疫干预治疗6个月后肾脏病缓解的预测模型。方法:纳入115例经肾脏病理确诊的MN患者,收集69例患者免疫干预6个月后的血清标本,检测血清磷脂酶A2受体(PLA2R)及结构域抗体水平。采用LASSO回归筛选变量,构建多因素Logistic回归模型,并通过ROC曲线等评估模型的预测能力。结果:LASSO回归筛选出lnCTLD1-IgG-M0和lnCTLD1-IgG4-M0为影响MN患者治疗6个月后肾脏缓解的独立危险因素。复合预测模型的预测能力优于传统PLA2R抗体指标。结论:lnCTLD1-IgG-M0和lnCTLD1-IgG4-M0是预测MN患者肾脏缓解的主要风险因素。基于PLA2R结构域抗体构建的预测模型具有良好的判别和校准能力,可为临床提供有效的预测工具,改善MN患者的肾脏预后。
Objective:To construct a model for predicting the probability of renal response at 6 months after immunosuppressive therapy in patients with membranous nephropathy(MN).Methodology:A total of 115 MN patients confirmed by renal pathology were enrolled,and serum samples from 69 patients were collected 6 months after immunosuppressive therapy to measure phospholipase A2 receptor(PLA2R)and domain-specific antibody levels.LASSO regression was used to screen variables,and a multivariate Logistic regression model was constructed.The predictive ability of the model was evaluated using ROC curves.Results:LASSO regression identified lnCTLD1-IgG-M0 and lnCTLD1-IgG4-M0 as independent risk factors affecting renal response in MN patients after 6 months of treatment.The composite predictive model outperformed conventional PLA2R antibody indices in predictive capability.Conclusion:lnCTLD1-IgG-M0 and lnCTLD1-IgG4-M0 are the main risk factors for predicting renal remission in MN patients.The prediction model based on PLA2R domain-specific antibodies exhibits excellent discriminative and calibration abilities,providing a valuable predictive tool for clinical practice to improve renal outcomes in MN patients.
作者
薛婧
陈彩妹
刘晓斌
刘斌
黄彪
王凉
XUE Jing;CHEN Caimai;LIU Xiaobin;LIU Bin;HUANG Biao;WANG Liang(Department of Nephrology,The Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi Medical Center,Nanjing Medical University,Wuxi 214023,China;College of Life Science and Medicine,Zhejiang University of Science and Technology,Hangzhou 310018,China)
出处
《肾脏病与透析肾移植杂志》
2025年第4期315-320,353,共7页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
无锡市医学创新团队(CXTD2021010)
无锡市“双百”中青年医疗卫生拔尖人才(HB2023009)
南京医科大学无锡医学中心专病队列(WMCC202316)。
关键词
膜性肾病
磷脂酶A2受体抗体
表位扩散
membranous nephropathy
phospholipase A2 receptor antibody
epitope spreading
