狼疮性肾炎患者24 h尿蛋白水平与肾小球微血栓形成的相关性  

Correlation between 24-hour urine protein levels and glomerular microthrombosis in patients with lupus nephritis

作　　者：陈建宇 胡豪飞 刘洋[1] 万启军[1] CHEN Jian-yu;HU Hao-fei;LIU Yang;WAN Qi-jun(Department of Nephrology,Shenzhen Second People's Hospital,the First Affiliated Hospital of Shenzhen University,Shenzhen 518000,Guangdong,CHINA)

机构地区：[1]深圳市第二人民医院肾内科&深圳大学第一附属医院肾内科,广东深圳518000

出　　处：《海南医学》2021年第1期16-21,共6页Hainan Medical Journal

基　　金：广东省深圳市医学重点学科建设经费资助(编号:SZXK009);广东省深圳市医疗卫生三名工程项目(编号:SZSM201512004)。

摘　　要：目的探讨狼疮性肾炎(LN)患者24 h尿蛋白水平与肾小球微血栓(GMT)形成的关系。方法回顾性分析深圳市第二人民医院肾内科2010年1月至2019年12月收治的116例经肾活检诊断为LN患者的临床和病理资料。采用Logistic回归分析24 h尿蛋白定量与GMT形成的关系;采用平滑曲线拟合分析24 h尿蛋白与GMT形成可能的曲线关系;采用受试者工作特征曲线(ROC)分析24 h尿蛋白定量对GMT形成的诊断价值。结果Logistic回归分析结果显示,24 h尿蛋白定量与LN患者GMT形成风险独立相关,尿蛋白每增加1g/24 h,GMT形成的风险增加31.3%(OR=1.313,95%CI 1.038~1.662,P=0.02330);平滑曲线拟合分析结果显示,24 h尿蛋白定量与LN患者GMT形成呈曲线关系,即当尿蛋白定量小于7 g/24 h时,尿蛋白水平与GMT形成正相关(OR=1.784,95%CI 1.138~2.797,P=0.01),在24 h尿蛋白大于7 g时,尿蛋白与GMT形成关系不显著(OR=0.154,95%CI 0.017~1.363,P=0.09);ROC曲线分析结果提示,24 h尿蛋白诊断肾小球微血栓形成的最佳临界值为1.27 g。结论24 h尿蛋白定量是LN患者GMT形成的独立影响因素。24 h尿蛋白定量与GMT形成的关系呈曲线关系,具有饱和效应,在24 h尿蛋白小于7g时,随着24 h尿蛋白增多,GMT的风险逐步增加,当24 h尿蛋白大于7 g时,两者关系不显著。24 h尿蛋白水平小于1.27 g时GMT发生的风险下降,24 h尿蛋白水平对于GMT形成有一定的预测价值。Objective To explore the relationship between 24-hour urinary protein levels and the formation of glomerular microthrombosis(GMT)in patients with lupus nephritis(LN).Methods The clinical and pathological data of 116 patients diagnosed with lupus nephritis by renal biopsy from January 2010 to December 2019 in Shenzhen Second People's Hospital was retrospectively studied.Logistic regression was used to analyze the relationship between 24-hour urine protein quantitation and glomerular microthrombosis;smooth curve fitting was used to analyze the possible curve relationship between 24-hour urine protein and glomerular microthrombosis;receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of 24-hour urine protein quantification for glomerular microthrombosis.Results Logistic regression analysis showed that 24-hour urine protein quantification was independently related to the risk of GMT formation in LN patients.For every increase of 1 g/24 h in urine protein,the risk of GMT formation increased by 31.3%(OR=1.313,95%CI 1.038-1.662,P=0.02330);the results of smooth curve fitting analysis showed that the 24-hour urine protein quantification was in a curvilinear relationship with the GMT formation of LN patients,that is,when the urine protein quantification was less than 7 g/24 h,the urine protein level was positively correlated with GMT(OR=1.784,95%CI 1.138-2.797,P=0.01).When the 24-hour urine protein was greater than 7 g,the relationship between urine protein and microthrombus was not obvious(OR=0.154,95%CI 0.017-1.363,P=0.09),ROC curve analysis results indicate that the best cut-off value of 24-hour urine protein to diagnose microthrombus was 1.27 g.Conclusion 24-hour urine protein quantification is an independent risk factor for glomerular microthrombosis in patients with lupus nephritis.The relationship between 24-hour urine protein quantitation and glomerular microthrombosis also show a curvilinear relationship.When the 24-hour urine protein is less than 7 g,the greater the 24-hour urine p

关 键 词：系统性红斑狼疮 狼疮性肾炎 24 h尿蛋白定量 肾小球微血栓 肾功能损伤 系统性红斑狼疮活动度评分 

分 类 号：R692.3[医药卫生—泌尿科学]