IgA肾病患者并发高尿酸血症的影响因素及其列线图预警模型构建  

Influencing factors of IgA nephropathy combined with hyperuricemia and a nomogram to predict the risk of hyperuricemia in IgA nephropathy patients

作　　者：周杰 冼炜瑩 李济填 曾今诚 Zhou Jie;Xian Wei-ying;Li Ji-tian;Zeng Jin-cheng(Guangdong Medical University,Dongguan Key Laboratory of Medical Bioactive Molecular Develop-mental and Translational Research,Guangdong Provincial Key Laboratory of Medical Immunology and Molecular Diagnostics,Zhanjiang 524023,China;Department of Clinical Laboratory,Shenzhen Univer-sity General Hospital,Shenzhen 518071,China;Department of Nephrology,Shenzhen University General Hospital,Shenzhen 518071,China)

机构地区：[1]广东医科大学,东莞市医学活性分子开发与转化重点实验室,广东省医学免疫与分子诊断重点实验室,湛江524023 [2]深圳大学总医院检验科,深圳518071 [3]深圳大学总院肾脏病科,深圳518071

出　　处：《临床肾脏病杂志》2025年第1期35-42,共8页Journal Of Clinical Nephrology

摘　　要：目的探究IgA肾病(IgA nephropathy,IgAN)患者并发高尿酸血症(hyperuricaemia,HUA)的影响因素并构建列线图预警模型。方法选取深圳大学总医院2020年12月1日至2023年12月1日收治的332例IgAN患者作为观察对象,按随机数字表法按比例(7∶3)分为建模组(233例)与验证组(99例)。将建模组根据是否发生HUA分为HUA组和非HUA组。多因素Logistic回归分析IgAN患者发生HUA的危险因素。R软件构建预测IgAN患者发生HUA的列线图模型。绘制受试者工作特征曲线(receiver operating characteristic,ROC)评估预测IgAN患者发生HUA的列线图模型区分度;绘制校准曲线评估模型的一致性。使用临床决策曲线(decision curve analysis,DCA)对该模型的临床应用价值进行评估。结果本研究建模组233例患者中有79例发生HUA,发生率为33.91%。HUA组和非HUA组患者在男性(65.82%比47.40%)、体重指数(body mass index,BMI)[(24.67±4.52)kg/m^(2)比(22.28±3.17)kg/m^(2)]、高血压(43.04%比23.38%)、三酰甘油(triglyceride,TG)[(2.16±0.61)mmol/L比(1.72±0.30)mmol/L]、白细胞[(7.28±2.06)×10^(9)L比(5.75±1.52)×10^(9)L]、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)[(66.93±19.85)mL·min^(-1)·(1.73 m^(2))-1比(86.42±22.37)mL·min^(-1)·(1.73 m^(2))-1]和IgA/C3[(3.07±0.96)比(2.35±0.62)]方面比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,男性(OR=6.147,95%CI:2.303~16.411)、BMI(OR=4.201,95%CI:2.740~6.440)、高血压(OR=12.935,95%CI:3.589~46.615)、TG(OR=3.057,95%CI:1.097~8.521)、白细胞(OR=4.876,95%CI:2.500~9.510)、IgA/C3(OR=2.657,95%CI:1.473~4.793)是IgAN患者发生HUA的危险因素(P<0.05),eGFR(OR=0.547,95%CI:0.303~0.987)是保护因素(P<0.05)。建模组ROC曲线下面积(area under curve,AUC)为0.912(95%CI:0.872~0.952),H-L检验χ^(2)=6.579,P=0.654。内部验证AUC为0.913(95%CI:0.855~0.971),H-L检验χ^(2)=6.486,P=0.723。由DCA曲线可知,高风险阈值概率在0.04~0.84时,该模型预测IgAN患者发生Objective To investigate the factors influencing the complication of hyperuricemia(HUA)in patients with immunoglobulin A nephropathy(IgAN)and to construct a nomogram to predict it.Methods From December 1,2020 to December 1,2023,332 IgAN patients admitted to Shenzhen University General Hospital were regarded as the observation subjects.They were randomly grouped into a modeling group(233 cases)and a validation group(99 cases)at a ratio of 7∶3 using a random num-ber table method.According to the presence of HUA,patients in the modeling group were assigned into HUA group and non-HUA group.Multivariate logistic regression was applied to analyze the risk factors for HUA in IgAN patients.R software was applied to construct a nomogram to predict the occurrence of HUA in IgAN patients.The receiver operating characteristic(ROC)curve was plotted to evaluate the discriminability of the nomogram in predicting HUA in IgAN patients.Calibration curves were plotted to assess the consistency of the nomogram.The value of the clinical application of the model was assessed using clinical decision curve analysis(DCA).Results HUA occurred in 79 out of 233 IgAN patients in the modelling group,with an incidence rate of 33.91%.There were significant differences in the male proportion(65.82%vs 47.40%),body mass index[BMI,(24.67±4.52)kg/m^(2) vs(22.28±3.17)kg/m^(2)],hypertension(43.04%vs 23.38%),triglyceride[TG,(2.16±0.61)mmol/L vs(1.72±0.30)mmol/L],white blood cell count[WBC,(7.28±2.06)×10^(9)L vs(5.75±1.52)×10^(9)L],estimated glomerular fil-tration rate[eGFR,(66.93±19.85)mL·min^(-1)·(1.73 m^(2))-1 vs(86.42±22.37)mL·min^(-1)·(1.73 m^(2))-1]and IgA/C3[(3.07±0.96)vs(2.35±0.62)]between HUA group and non-HUA group(P<0.05).Multivariate logistic regression analysis showed that male gender(OR=6.147,95%CI:2.303-16.411),BMI(OR=4.201,95%CI:2.740-6.440),hypertension(OR=12.935,95%CI:3.589-46.615),TG(OR=3.057,95%CI:1.097-8.521),WBC(OR=4.876,95%CI:2.500-9.510),and IgA/C3(OR=2.657,95%CI:1.473-4.793)were the risk factors for the develop

关 键 词：IGA肾病 高尿酸血症 影响因素 列线图 预警模型 

分 类 号：R69[医药卫生—泌尿科学]