狼疮肾炎患者感染的危险因素与预测模型的构建

    Risk factors for infections in patients with lupus nephritis and construction of a prediction model

    • 摘要: 目的 探究狼疮肾炎(lupus nephritis,LN)患者在开始免疫抑制治疗后感染的危险因素。方法 回顾性收集2000年1月1日至2020年12月31日在南方医科大学附属广东省人民医院(广东省医学科学院)诊断为LN并接受免疫抑制治疗的患者374例。收集患者基本情况,肾脏病理指标,生化、免疫等指标的基线及变化,以及随访中患者发生感染的情况。采用Cox比例风险回归模型分析继发感染的影响因素。结果 纳入患者的年龄为(30 ±12)岁,女性患者占比85.3%,平均随访时间2年,随访期间有219(58.6%)例LN患者出现感染。多因素Cox比例风险回归模型分析显示,基线IgM(HR=1.288,95%CI:1.074~1.544,P=0.006)和游离轻链λ水平(HR=1.783,95%CI:1.000~3.177,P=0.050)是LN患者继发感染的危险因素,而治疗后3个月内抗双链(double-stranded,ds)DNA的减少(HR=0.728,95%CI:0.563~0.924,P=0.016)和血红蛋白升高(HR=0.790,95%CI:0.652~0.958,P=0.017)是感染的保护因素。将变量进行标准化并剔除3个月内感染的患者后进行多因素分析绘制列线图,并且绘制受试者工作特征曲线,曲线下面积为0.825。结论 LN患者在治疗期间发生感染的发生率较高。基线IgM和血清轻链λ高水平与LN患者免疫抑制治疗后感染风险增加相关,而治疗后3个月内dsDNA抗体的下降和血红蛋白的增加与LN患者感染风险下降有关。本研究构建的模型对LN患者感染的危险因素的发生具有较好的预测能力。

       

      Abstract: Objective To investigate the risk factors for infection in lupus nephritis (LN) after starting immunosuppressive therapy.Methods A total of 374 patients who were diagnosed with LN and received immunosuppressive therapy at Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences),Southern Medical University from January 1, 2000 to December 31, 2020 were retrospectively collected. The basic conditions of the patients, renal pathologic indexes, baseline and changes in biochemical and immunologic indexes, and the occurrence of infections during follow-up were collected. Cox proportional risk regression model was used to analyze the factors affecting secondary infections.Results The mean age of the included patients was (30 ±12)years, and 85.3% of them were female. The mean follow-up period was 2 years. During the follow-up, 219 (58.6%) LN patients developed infections. Multifactorial Cox proportional risk regression model analysis showed that baseline IgM (HR=1.288,95% CI: 1.074-1.544, P=0.006) and free light chain λ levels (HR=1.783,95% CI: 1.000-3.177, P=0.050) were the risk factors for secondary infections in LN patients, whereas the reduction of double-stranded DNA (dsDNA) at 3 months of treatment (HR=0.728, 95% CI: 0.563-0.924, P=0.016) and hemoglobin elevation (HR=0.790,95% CI: 0.652-0.958, P=0.017) were protective factors for infection. After standardizing the variables and excluding patients with infections within 3 months, a multivariate analysis was performed, and a nomogram was constructed. The receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) of the nomogram was 0.825.Conclusion Patients with LN have a higher incidence of infections during the treatment period. High baseline levels of IgM and serum light chain λ are associated with an increased risk of infection after immunosuppressive therapy in LN patients, whereas a decrease in dsDNA antibodies and an increase in hemoglobin are associated with a decreased risk of infection in patients with LN within 3 months of treatment. The nomogram constructed in this study has a good predictive ability for the occurrence of risk factors for infection in LN patients.

       

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