摘要
目的本研究旨在探索难治性膜性肾病的临床特征及其独立危险因素,为精准治疗提供依据。方法回顾性纳入2008年1月至2024年12月在首都医科大学附属北京同仁医院接受标准免疫抑制治疗≥6个月的特发性膜性肾病患者104例,根据治疗6个月后的反应分组:完全缓解组(n=19;尿蛋白<0.3g/24h,白蛋白≥30g/L,肾功能稳定),难治组(n=24;尿蛋白>3.5g/24h伴白蛋白<30g/L),部分缓解组(n=61,未达到完全缓解或难治)。排除部分缓解组患者,对比分析完全缓解组和难治组基线资料,进一步采用logistic回归分析难治性膜性肾病的独立危险因素。结果与完全缓解组相比,难治组患者年龄更小、男性比例更高;高密度脂蛋白胆固醇及免疫球蛋白G水平更低;中性粒细胞/淋巴细胞比值、血清补体C3、补体C4水平更高(P<0.05)。多因素logistic回归分析显示,男性(OR=11.284)及高补体C3水平(OR=1.006)是难治性膜性肾病的独立危险因素(P<0.05)。结论男性及高补体C3水平是难治性膜性肾病的独立危险因素,识别这些特征可能有助于早期预测膜性肾病难治风险并指导个体化治疗决策。
Objective To explore the clinical characteristics and risk factors of refractory membranous nephropathy(RMN),thereby providing a solid foundation for precise treatment strategies.Method A retrospective study was carried out on 104 patients diagnosed with idiopathic membranous nephropathy who had received standard immunosuppressive therapy for a minimum of six months at Beijing Tongren Hospital Affiliated to Capital Medical University between January 2008 and December 2024.Patients were categorized into 3 groups according to their response after treatment of six months:the complete remission(CR)group(n=19;urine protein<0.3g/24 h,albumin≥30g/L,and stable renal function);the RMN group(n=24;urine protein>3.5g/24h and albumin<30g/L);the partial response(PR)group(n=61,patients who do not achieve CR or RMN).Patients with partial remission were excluded.Baseline clinical data and laboratory test results were collected and compared between the CR and RMN groups.Logistic regression analysis was employed to identify the independent risk factors associated with RMN.Result Compared to the CR group,patients in the RMN group were younger,had a higher male-to-female ratio,lower levels of high-density lipoprotein cholesterol(HDL-C)and immunoglobulin G(IgG),and higher values of neutrophil-tolymphocyte ratio(NLR),serum complement C3,and complement C4(all P<0.05).Multivariate logistic regression analysis indicated that male gender[odds ratio(OR)=11.284]and a high complement C3 level(OR=1.006)were independent risk factors for RMN(P<0.05).Conclusion Male and high serum complement C3 level were novel independent risk factors of RMN.Identifying these characteristics could potentially assist in the prediction of the risk of RMN and guide individualized treatment decisions.
作者
宋康康
李冰寒
张国娟
SONG Kangkang;LI Binghan;ZHANG Guojuan(Authors Affiliation:Department of Nephrology,Beijing Tongren Hospital,Capital Medical University,Beijing 100073,China)
出处
《中国临床医生杂志》
2026年第2期156-160,共5页
Chinese Journal For Clinicians
基金
北京市自然科学基金(7212021)。
