人工智能肾脏病理分析系统在膜性肾病中的应用  

Application of artificial intelligence-based analytic renal pathology system in patients with membranous nephropathy

作　　者：梁冬梅 雷群娟 刘许蒙 徐峰 梁少姗 梁丹丹 杨帆 曾彩虹 LIANG Dongmei;LEI Qunjuan;LIU Xumeng;XU Feng;LIANG Shaoshan;LIANG Dandan;YANG Fan;ZENG Caihong(National Clinical Research Center of Kidney Diseases,Jinling Hospital,Nanjing University School of Medicine,Nanjing 210016,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)国家肾脏疾病临床医学研究中心、全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2023年第3期201-206,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金面上项目(82070793);江苏省卫生健康委医学科研重点项目(ZD2021018)。

摘　　要：目的:探讨基于人工智能技术构建的肾脏病理分析系统(ARPS)在原发性膜性肾病(PMN)中的应用。方法:纳入2018年1月至2019年12月于国家肾脏疾病临床医学研究中心经肾活检诊断为PMN的患者。评估ARPS对肾小球病变类型[球性硬化(GS);节段硬化(SS);非上述病变肾小球(NOA)]及三种固有细胞(系膜细胞、内皮细胞、足细胞)的识别效果,并分析基于ARPS的肾小球特征与预后的关系。结果:共纳入123例PMN患者,男性80例、女性43例,平均年龄47.1±14.0岁。ARPS对NOA、GS和SS识别F1分数分别为0.967、0.811和0.545,肾小球三种固有细胞的F1分数均>0.950。尿蛋白未缓解患者肾小球面积大于缓解患者,足细胞平均数、密度和比值均低于缓解患者。足细胞平均数和密度较高的患者肾脏缓解率高于足细胞平均数和密度较低的患者。多因素分析提示肾组织磷脂酶A2受体(PLA2R)阳性和足细胞平均数是尿蛋白缓解的独立预测因子。结论:ARPS对PMN患者肾小球病变和固有细胞类型识别效果较好,基于ARPS的肾小球特征与患者预后存在明显相关性。Objective:To explore the application of artificial intelligence-based analytic renal pathology system(ARPS)in patients with primary membranous nephropathy(PMN).Methodology:Patients with biopsy-proven PMN in our center from January 2018 to December 2019 were enrolled.Their clinical and pathological data were collected.ARPS was applied to identify glomeruli lesions including global glomerular sclerosis(GS),segmental glomerular sclerosis(SS),crescents(C),and none of the above(NOA),and then quantify intraglomerular features,including intrinsic glomerular cells(M:mesangial cells;E:endothelial cells;P:podocytes)and glomerular area.The performance of ARPS was evaluated.The relationships between ARPSbased intraglomerular features and prognosis were further analyzed.Results:A total of 123 patients(65.0%males)were included.The average age was 47.1±14.0 years at biopsy.For the identification of glomerular lesions,ARPS achieved the best effect in NOA with 0.967 F1-score;followed by GS with 0.811 F1-score and SS with 0.545 F1-score.The F1-scores of ARPS on identifying intrinsic cells were greater than 0.950.The glomerular area was larger in no response(NR)patients than that in partial remission(PR)and complete remission(CR)patients;the number,density and ratio of podocytes were higher in CR patients than that in PR and NR patients.The remission rate of urinary protein was higher in patients with higher podocytes number or density than that in patients with lower podocytes number or density.Renal phospholipase A2 receptor(PLA2R)and podocyte number were independent predictors of urinary protein remission.Conclusion:ARPS performed well in the identification of glomerular lesions and intrinsic cell types in PMN.The ARPSbased intraglomerular characteristics were significantly correlated with prognosis in PMN patients.

关 键 词：人工智能 病理 原发性膜性肾病 肾小球病变类型 固有细胞 

分 类 号：R692[医药卫生—泌尿科学]