特发性膜性肾病合并急性肾损伤的危险因素分析^*

Risk Factors for Idiopathic Membranous Nephropathy Complicated by Acute Kidney Injury

摘要

目的 探究基于倾向性评分匹配的特发性膜性肾病合并急性肾损伤危险因素。方法 回顾性纳入2020年1月-2025年3月的310例特发性膜性肾病患者，分为急性肾损伤组（n=80）和非急性肾损伤组（n=230），从非急性肾损伤组中选择患者和急性肾损伤组患者进行PSM 1∶1匹配，获得80对数据。收集其一般资料，主要结局指标为血清肌酐、估算的肾小球滤过率（estimated glomerular filtration rate, eGFR）、血尿酸、血清P-选择素、尿肾脏损伤分子1（kidney injury molecule-1, KIM-1）水平。通过Logistic回归分析确定特发性膜性肾病合并急性肾损伤危险因素，构建特发性膜性肾病合并急性肾损伤的列线图模型。结果 匹配后，急性肾损伤组患者的5项主要结局指标与非急性肾损伤组相比，差异均有统计学意义（均P<0.05）。多因素logistic回归分析结果显示，血肌酐、eGFR、血尿酸、血清P-选择素均是特发性膜性肾病患者合并急性肾损伤的影响因素（均P<0.05）。基于上述4项影响因素构建的联合预测模型（列线图）的ROC曲线下面积（AUC）为0.945（95%CI: 0.909～0.981），校准曲线显示预测曲线与理想曲线拟合良好。Hosmer-Lemeshow检验结果支持模型校准度（χ²=7.366，P=0.498）。SHAP重要性排序显示，P-选择素是特发性膜性肾病合并急性肾损伤的重要影响因素，血尿酸、eGFR和血肌酐的重要性次之。结论 血肌酐、eGFR、血尿酸以及血清P-选择素是患者并发急性肾损伤的独立影响因素，且具有一定的预测价值。

Abstract

Objective To investigate the risk factors for idiopathic membranous nephropathy (IMN) complicated by acute kidney injury (AKI) based on propensity score matching (PSM). Methods A total of 310 IMN patients admitted between January 2020 and March 2025 were retrospectively enrolled and divided into an AKI group (n = 80) and a non-AKI group (n = 230). Patients in the non-AKI group were matched with those in the AKI group at a 1:1 ratio using PSM, resulting in 80 matched pairs. The general data of the patients were collected. The primary outcome measures included serum creatinine, estimated glomerular filtration rate (eGFR), uric acid, P-selectin, and urinary kidney injury molecule-1 (KIM-1) levels. Logistic regression analysis was performed to identify factors associated with risks for IMN complicated by AKI, and a nomogram prediction model was subsequently established. Results After PSM, all 5 primary outcome measures differed significantly between the AKI and non-AKI groups (all P < 0.05). According to multivariate logistic regression analysis, 4 outcome measures, including serum creatinine, eGFR, serum uric acid, and serum P-selectin, were all identified as factors influencing the occurrence of AKI in patients with IMN (all P < 0.05). A combined prediction model (a nomogram model) incorporating these 4 variables yielded an area under the curve (AUC) of the receiver operating characteristic curve (ROC) of 0.945 (95% CI: 0.909-0.981). The calibration curve demonstrated a good fit between the predicted and the ideal curves. Findings from the Hosmer-Lemeshow goodness-of-fit test supported adequate calibration of the model ( χ² = 7.366, P = 0.498). Shapley additive explanations (SHAP) importance ranking analysis showed that serum P-selectin was an important influencing factor for AKI in patients with IMN, and the importance of serum uric acid, eGFR, and serum creatinine was secondary. Conclusion Serum creatinine, eGFR, blood uric acid, and serum P-selectin are independent influencing factors for patients with acute kidney injury, and they have certain predictive value.

关键词

特发性膜性肾病 / 急性肾损伤 / 倾向性评分匹配 / 危险因素

Key words

Idiopathic membranous nephropathy / Acute kidney injury / Propensity score matching / Risk factors

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基金资助

*福建省卫健委青年科研基金(2021QN01010226)