基于倾向性评分匹配法高尿酸血症对IgA肾病预后的影响  

Effect of hyperuricemia on the prognosis of IgA nephropathy based on propensity score matching

作　　者：林宜[1,2] 朱斌 俞东容[1,2] 殷佳珍 王文荣[1,2] 汤绚丽 杜园园[1,2] 姜飞 袁辰怡[1] 高源成 陈洪宇[1,2] Lin Yi;Zhu Bin;Yu Dongrong;Yin Jiazhen;Wang Wenrong;Tang Xuanli;Du Yuanyuan;Jiang Fei;Yuan Chenyi;Gao Yuancheng;Chen Hongyu(Department of Nephrology,Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Traditional Chinese Medicine University,Hangzhou 310007,China;Zhejiang Key Laboratory of Prevention and Treatment of Kidney Diseases,Hangzhou 310007,China)

机构地区：[1]浙江中医药大学附属杭州市中医院肾内科,杭州310007 [2]浙江省肾脏疾病防治技术研究重点实验室,杭州310007

出　　处：《中华肾脏病杂志》2021年第6期465-473,共9页Chinese Journal of Nephrology

基　　金：浙江省基础公益项目(LGF18H050005);浙江省医药卫生科技计划(2015KYA191);浙江省中医药科技计划项目(2013ZA091);杭州市科技计划项目(20140733Q33);杭州市卫生局重点项目(2011Z013)。

摘　　要：目的采用倾向性评分匹配法(propensity score matching,PSM)探讨高尿酸血症对IgA肾病(IgA nephropathy,IgAN)预后的影响。方法纳入经肾活检证实为IgAN的患者,采用PSM对患者进行匹配,采用Kaplan-Meier法进行生存分析,采用Cox比例风险回归模型分析高尿酸血症对IgAN预后的影响,主要结局事件定义为死亡或到达肾脏结局[包含终末期肾衰竭(透析、移植)或估算肾小球滤过率(eGFR)下降>40%]。结果本研究最终纳入1454例IgAN患者,其中女性850例,男性604例。男性血尿酸水平为(368.26±92.87)μmol/L,女性血尿酸水平为(277.23±92.71)μmol/L,随访时间中位数为85.00(56.10,106.33)个月,随访期间共有134例患者发生主要结局事件,其中5例死亡,24例透析,5例肾移植,100例eGFR下降>40%。经过1∶1匹配,高尿酸血症组男性131例与正常血尿酸组男性131例、高尿酸血症组女性159例与正常血尿酸组女性159例匹配成功,匹配后男性和女性高尿酸血症组和正常血尿酸组间各项基线指标差异均无统计学意义。Kaplan-Meier生存分析表明,匹配前后男女高尿酸血症组患者的主要结局事件发生率均高于正常血尿酸组,但匹配后女性高尿酸血症组患者与正常血尿酸组患者的主要结局事件发生率差异无统计学意义(Log-rank检验,χ2=3.586,P=0.058)。Cox比例风险回归模型分析结果表明,在匹配前全因素校正模型中,男性高尿酸血症患者进入主要结局事件的风险(HR)是男性正常血尿酸患者的2.29倍(95%CI 1.27~4.11,P=0.006),女性则为1.85倍(95%CI 1.01~3.37,P=0.045);在匹配后全因素校正模型中,男性高尿酸血症患者进入主要结局事件的风险是男性正常血尿酸患者的2.41倍(95%CI 1.18~4.93,P=0.016),女性则为1.83倍(95%CI 0.91~3.67,P=0.091);在匹配前全因素校正模型中,男性高尿酸血症患者进入肾脏结局事件的风险是男性正常血尿酸患者的2.68倍(95%CI 1.47~4.88,P=0.001),女性则为1.81倍(95%CI 0.99~3Objective To investigate the effects of hyperuricemia on the prognosis of IgA nephropathy(IgAN)using propensity score matching(PSM)method.Methods IgAN patients proven by biopsy were included.PSM was used to match patients.Kaplan-Meier method was used for survival analysis,and Cox regression analysis was used to analyze the effects of hyperuricemia on IgAN prognosis.Primary outcome events were defined as death,or end-stage renal disease(dialysis,transplantation),or a decrease in estimated glomerular filtration rate(eGFR)greater than 40%.Renal outcome was defined as end-stage renal disease(dialysis,transplantation),or a decrease in eGFR greater than 40%.Results A total of 1454 IgAN patients were included in this study,including 850 females and 604 males.Uric acid level was(368.26±92.87)μmol/L in the males,and(277.23±92.71)μmol/L in the females.The median follow-up time was 85.00(56.10,106.33)months.During the follow-up period,a total of 134 patients reached the primary outcome events,including 5 deaths,24 dialysis patients,5 kidney transplant patients,and 100 patients with eGFR decreased by more than 40%.After 1∶1 matching,131 males and 159 females in the hyperuricemia group were successfully matched with 131 males and 159 females in the normal uric acid group,and there was no significant statistical difference in each parameter in baseline between the hyperuricemia group and normal uric acid group after matching.Kaplan-Meier survival analysis showed that either before or after matching,the incidence of primary outcome events in male or female patients with hyperuricemia was higher than those with normal uric acid,but there was no statistically significant difference in incidence of primary outcome events between female hyperuricemia group and female normal uric acid group after matching(Log-rank test,χ2=3.586,P=0.058).Cox proportional hazard regression model showed that,in the pre-match fully adjusted model,the hazard ratio(HR)of entering primary outcome events was 2.29-fold(95%CI 1.27-4.11,P=0.006)for men

关 键 词：肾小球肾炎 IgA 高尿酸血症 危险因素 预后 

分 类 号：R692.31[医药卫生—泌尿科学] R589.7[医药卫生—外科学]