摘要
目的探讨血清免疫球蛋白M(IgM)、凝血因子Ⅷ(FⅧ)与IgA肾病患者肾脏预后的关系。方法选取2017年6月至2019年6月该院收治的112例IgA肾病患者作为观察组,另外选取120例同期来该院体检的健康人作为对照组。根据肾小管间质损害程度,将IgA肾病患者分为轻度组(36例)、中度组(49例)和重度组(27例)。连续随访3年,根据IgA肾病患者肾脏预后情况,分为预后良好组(81例)和预后不良组(31例)。采用酶联免疫吸附试验检测血清IgM、FⅧ水平;采用受试者工作特征曲线评估血清IgM、FⅧ对IgA肾病患者肾脏预后的预测价值;采用多因素Logistic回归分析影响IgA肾病患者肾脏预后的危险因素。结果观察组血清IgM水平低于对照组,FⅧ水平高于对照组,差异均有统计学意义(P<0.05)。重度组血清IgM水平低于中度组、轻度组,血清FⅧ水平高于中度组、轻度组,且中度组血清IgM水平低于轻度组,血清FⅧ水平高于轻度组,差异均有统计学意义(P<0.05)。预后不良组血清IgM水平低于预后良好组,FⅧ水平高于预后良好组,差异均有统计学意义(P<0.05)。血红蛋白<120.0 g/L(OR=2.60,95%CI:1.39~4.87)、24 h尿蛋白定量≥1.5 g/24 h(OR=2.49,95%CI:1.37~4.53)、血肌酐≥106μmol/L(OR=2.36,95%CI:1.35~4.14)、血清IgM<0.81 g/L(OR=3.69,95%CI:1.57~8.66)、血清FⅧ≥174.24%(OR=3.04,95%CI:1.47~6.29)是IgA肾病患者发生肾脏预后不良的独立影响因素(P<0.05)。血清IgM、FⅧ预测IgA肾病患者肾脏预后的曲线下面积(AUC)分别为0.786(95%CI:0.726~0.846)、0.847(95%CI:0.797~0.897),截断值分别为0.81 g/L、174.24%,特异度分别为53.62%、67.43%,灵敏度均为92.12%,二者联合预测的AUC为0.916(95%CI:0.866~0.966),特异度为85.19%,灵敏度为86.97%。结论血清IgM、FⅧ水平与IgA肾病患者的疾病严重程度和肾脏预后显著相关,IgM水平越低、FⅧ水平越高,患者的病情越严重,预后越差,且二者联合检测有利于IgA肾病患者肾脏预后�
Objective To explore the relationship between serum immunoglobulin M(IgM),coagulation factorⅧ(FⅧ)and renal prognosis in patients with IgA nephropathy.Methods A total of 112 patients with IgA nephropathy admitted to the hospital from June 2017 to June 2019 were selected as the observation group,and 120 healthy people who came to the hospital for physical examination in the same period were se-lected as the control group.According to the degree of tubular interstitial damage,patients with IgA nephrop-athy were divided into mild group(36 cases),moderate group(49 cases)and severe group(27 cases).After 3 years of follow-up,the patients were divided into good prognosis group(81 cases)and poor prognosis group(31 cases)according to the renal prognosis.The enzyme-linked immunosorbent assay was used to detect ser-um levels of IgM and FⅧ,the receiver operating characteristic curve was adopted to evaluate the predictive value of serum IgM,FⅧin renal prognosis of patients with IgA nephropathy,and the multivariate Logistic re-gression analysis was employed to explore the risk factors of renal prognosis in patients with IgA nephropa-thy.Results Compared with the control group,the serum IgM level in the observation group was lower and the serum FⅧlevel was higher,the differences were statistically significant(P<0.05).The serum IgM level in the severe group was lower than that in the moderate group and the mild group,the serum FⅧlevel was higher than that in the moderate group and the mild group,meanwhile the serum IgM level in the moderate group was lower than that in the mild group,and the serum FⅧlevel was higher than that in the mild group,and the differences had statistical significance(P<0.05).The serum IgM level in the poor prognosis group was lower than that in the good prognosis group,and the serum FⅧlevel was higher than that in the good prognosis group,the differences were statistically significant(P<0.05).The levels of hemoglobin<120.0 g/L(OR=2.60,95%CI:1.39-4.87),24-hour proteinuria≥1.5 g/24 h(OR=2.
作者
邢明旭
李艳萍
付冬梅
赵敬
XING Mingxu;LI Yanping;FU Dongmei;ZHAO Jing(Department of Nephrology,Anyang Third People's Hospital,Anyang,Henan 455000,China)
出处
《检验医学与临床》
CAS
2023年第9期1249-1254,共6页
Laboratory Medicine and Clinic
