高血清胱抑素C水平是IgA肾病不良预后的独立危险因素  

High serum cystatin C is an independent risk factor for poor renal prognosis in IgA nephropathy

作　　者：唐天威 李路安 陈源汉[2] 张丽[2] 徐丽霞 李志莲[2] 冯仲林 张辉林 华瑞芳 叶智明[2] 梁馨苓[2] 李锐钊[1] TANG Tianwei;LI Luan;CHEN Yuanhan;ZHANG Li;XU Lixia;LI Zhilian;FENG Zhonglin;ZHANG Huilin;HUA Ruifang;YE Zhiming;LIANG Xinling;LI Ruizhao(Guangdong Cardiovascular Institute,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Nephrology,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China;Department of Nephrology,Ganzhou Hospital of Guangdong Provincial People's Hospital(Ganzhou Municipal Hospital),Ganzhou 341000,China)

机构地区：[1]广东省心血管病研究所//广东省人民医院//广东省医学科学院,广东广州510080 [2]南方医科大学附属广东省人民医院(广东省医学科学院)肾内科,广东广州510080 [3]广东省人民医院赣州医院(赣州市立医院)肾内科,江西赣州341000

出　　处：《南方医科大学学报》2025年第2期379-386,共8页Journal of Southern Medical University

基　　金：广东省基础与应用基础研究项目(2024A1515010424);广东省人民医院登峰计划(KJ012019440);广东省科技厅项目(2019B121205005);广州市科技基础与应用基础研究项目(202102080608)。

摘　　要：目的探讨血清胱抑素C(CysC)水平评估IgA肾病(IgAN)患者肾脏预后的价值。方法回顾性收集2014年1月~2018年12月在广东省人民医院通过肾穿刺活检诊断为IgAN患者的临床资料。根据基线血清CysC值将患者分为高血清CysC组(CysC>1.03 mg/L)和正常血清CysC组(CysC≤1.03 mg/L)。估算肾小球滤过率(eGFR)下降≥50%,和/或进入终末期肾病(ESRD)作为肾脏不良预后的随访复合终点事件。采用lasso回归和多因素Cox回归筛选独立危险因素,并基于这些独立危险因素构建多因素Cox回归预测模型。采用Kaplan⁃Meier生存分析比较两组之间的肾脏生存率差异。平滑曲线拟合及阈值效应探究血清CysC水平与结局之间的关系。通过Bootstrap法内部验证预测模型并使用一致性指数、校正曲线、受试者工作特征(ROC)曲线及其曲线下面积(AUC)对模型预测效能进行评价,并通过列线图可视化。结果本研究共纳入356例IgAN患者,平均随访时间为(4.65±0.93)年,74例发生肾脏不良预后的复合终点事件。高血清CysC被筛选为IgAN肾脏不良预后的独立危险因素(HR=2.142,95%CI:1.222~3.755),且血清CysC水平高的患者肾脏生存率较低(Log-rank检验χ^(2)=47.970,P<0.001)。阈值效应分析显示,当患者血清CysC≤2.12 mg/L时,血清CysC水平越高,肾脏不良预后风险越大(β=3.487,95%CI:2.561~4.413,P<0.001);当患者的血清CysC>2.12 mg/L时,肾脏不良预后的发生风险仍有上升但差异无统计学意义(β=0.676,95%CI:-0.642~1.995,P=0.315)。基于血清CysC及其他3个独立危险因素构建的多因素Cox回归预测模型经内部验证表现良好,其一致性指数为0.873(95%CI:0.839~0.907),AUC为0.909(95%CI:0.873~0.945)。结论血清CysC水平与IgAN患者肾脏预后相关,高血清CysC是IgA肾病不良预后的独立危险因素。Objective To explore the value of serum cystatin C(CysC)levels in evaluating renal prognosis in IgA nephropathy(IgAN)patients.Methods We retrospectively collected the clinical data of IgAN patients diagnosed by renal biopsy at Guangdong Provincial People's Hospital from January,2014 to December,2018.Based on baseline serum CysC levels,the patients were divided into high serum CysC(>1.03 mg/L)group and normal serum CysC(≤1.03 mg/L)group.The composite endpoint for poor renal prognosis was defined as≥50% decline in estimated glomerular filtration rate(eGFR)and/or progression to end-stage renal disease(ESRD).Lasso regression,multivariate Cox regression and Kaplan-Meier survival analysis were used to identify the risk factors and compare renal survival rates between the two groups.Smooth curves fitting and threshold effect analysis were used to explore the relationship between serum CysC levels and the outcomes.A nomogram model was constructed and its predictive performance was evaluated using concordance index,calibration curve,receiver operating characteristic(ROC)curve and the area under curve(AUC).Results A total of 356 IgAN patients were enrolled,who were followed up for 4.65±0.93 years.The composite endpoint occurred in 74 patients.High serum CysC was identified as an independent risk factor for poor renal prognosis in IgAN(HR=2.142,95%CI 1.222 to 3.755),and the patients with high serum CysC levels had a lower renal survival rate(Log-rank χ^(2)=47.970,P<0.001).In patients with serum CysC below 2.12 mg/L,a higher CysC level was associated with an increased risk of poor renal prognosis(β=3.487,95%CI:2.561-4.413,P<0.001),while above this level,the increase of the risk was not significant(β=0.676,95%CI:-0.642-1.995,P=0.315).The nomogram model based on serum CysC and 3 other independent risk factors demonstrated good internal validity with a concordance index of 0.873(95%CI:0.839-0.907)and an AUC of 0.909(95%CI:0.873-0.945).Conclusion Serum CysC levels are associated with renal prognosis in IgAN patients,and

关 键 词：血清胱抑素C IGA肾病 预后 

分 类 号：R69[医药卫生—泌尿科学]