摘要
目的探讨C反应蛋白-白蛋白-淋巴细胞(C-reactive protein-albumin-lymphocyte,CALLY)指数对IgA肾病(IgA nephropathy,IgAN)患者预后的影响。方法选取2019年11月至2023年11月在中国科学技术大学附属第一医院(安徽省立医院)南区经肾活检诊断为IgAN的266例患者,随访至少3个月,主要终点事件为死亡或肾脏复合结局。使用受试者工作特征曲线下面积(area under the receiver operating characteristic curve,AUROC)评估CALLY指数对终点事件的预测效能。根据CALLY指数的最佳截断值将患者分为两组:高CALLY指数组(n=151)和低CALLY指数组(n=115)。通过Kaplan-Meier生存分析和Cox比例风险回归模型评估CALLY指数对IgAN预后的影响,并计算CALLY指数对IgAN终点事件的HR、AHR及95%CI。结果两组患者性别、体重指数、收缩压、舒张压、高血压病史、高尿酸血症病史、估算肾小球滤过率、24 h尿蛋白量、血肌酐、尿酸、尿素氮等一般资料比较,差异均无统计学意义(P>0.05)。低CALLY指数组患者的C反应蛋白水平[(3.76±1.71)mg/L比(2.19±1.19)mg/L]显著高于高CALLY指数组,而高CALLY指数组患者的淋巴细胞计数[(2.22±0.57)×10^(9)比(1.75±0.41)×10^(9)]、白蛋白[(39.29±4.56)g/L比(34.78±7.27)g/L]、血红蛋白[(126.72±16.97)g/L比(121.81±15.38)g/L]及E0例数(95例比55例)则更高,差异均具有统计学意义(P<0.05)。Kaplan-Meier曲线显示CALLY指数与IgAN患者结局密切相关,多因素Cox回归分析显示CALLY指数(AHR=0.806,95%CI:0.676~0.963,P=0.017)是IgAN患者预后的独立影响因素。AUROC显示CALLY指数的预测能力优于血小板与白蛋白比值及血小板与淋巴细胞比值,CALLY指数和24 h尿蛋白量联合使用能够进一步提高对IgAN患者预后的预测效能。结论CALLY指数可被认为是IgAN患者预后的重要预测指标,其在临床实践中可能会进一步提高对IgAN患者进展风险的精准判断,可能为临床决策的制定提供重要参考依据。
Objective To evaluate the prognostic value of the C-reactive protein-albuminlymphocyte(CALLY)index in patients with IgA nephropathy(IgAN).Methods We retrospectively enrolled 266 patients with biopsy-proven IgAN treated at the South Campus of the First Affiliated Hospital of USTC(Anhui Provincial Hospital)between November 2019 and November 2023.All patients were followed for at least 3 months.The primary endpoint was death or a renal composite outcome.The area under the receiver operating characteristic curve(AUROC)was used to evaluate the predictive performance of the CALLY index for the endpoint.Patients were dichotomized by the optimal CALLY cutoff into a high-CALLY group(n=151)and a low-CALLY group(n=115).Kaplan-Meier survival analysis and Cox proportional hazards regression were used to evaluate the association between CALLY and prognosis;hazard ratios(HR),adjusted HRs(AHR),and 95%confidence intervals(95%CI)were reported.Results Baseline characteristics-sex,body mass index,systolic and diastolic blood pressure,history of hypertension,history of hyperuricemia,estimated glomerular filtration rate(eGFR),24-hour urinary protein,serum creatinine,uric acid,and blood urea nitrogen-did not differ significantly between groups(all P>0.05).The low-CALLY group had significantly higher C-reactive protein[(3.76±1.71)mg/L vs(2.19±1.19)mg/L],while the high-CALLY group had higher lymphocyte count[(2.22±0.57)×10^(9)/L vs(1.75±0.41)×10^(9)/L],serum albumin[(39.29±4.56)g/L vs(34.78±7.27)g/L],hemoglobin[(126.72±16.97)g/L vs(121.81±15.38)g/L],and more E0 cases(95 vs 55);these differences were statistically significant(all P<0.05).Kaplan-Meier analysis demonstrated a significant association between CALLY index and clinical outcomes.In multivariable Cox regression,CALLY remained an independent predictor of prognosis(AHR=0.806;95%CI:0.676-0.963;P=0.017).AUROC analysis indicated that the CALLY index outperformed the platelet‑to‑albumin ratio and platelet‑to‑lymphocyte ratio in predicting outcomes.Combining CALLY with 24‑hour urinary protein further improved prognostic discrimination.Conclusion The CALLY index is a significant and independent prognostic marker in IgA nephropathy.Its application in clinical practice may enhance risk stratification and support decision‑making regarding disease management.
作者
王子晗
朱薇
方园园
王丽华
彭丽
兰雷
姜俊
Wang Zi-han;Zhu Wei;Fang Yuan-yuan;Wang Li-hua;Peng Li;Lan Lei;Jiang Jun(Graduate School of Bengbu Medical University,Bengbu 233030,China;Department of Nephrology,The First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230000,China)
出处
《临床肾脏病杂志》
2026年第1期23-32,共10页
Journal of Clinical Nephrology
基金
中国初级卫生保健基金(2022KY114)。
