个性化预测儿童紫癜性肾炎发生风险的列线图建立
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摘要
目的:探讨过敏性紫癜(HSP)患儿发生肾脏损害的相关危险因素,初步构建儿童紫癜性肾炎(HSPN)的风险预测列线图。方法:选取192例HSP患儿为研究对象,根据尿检结果将患儿分为HSPN组(59例)和NHSPN组(133例)。采用单因素及多因素分析方法筛选肾损害高危因素并建立列线图,采用ROC曲线下面积(AUC)来评价模型预测效能。结果:年龄、皮疹反复≥4周、ALB降低、Cys-C升高和夹瘀证是影响HSPN发生的独立危险因素(P<0.05)。对列线图模型的预测概率行ROC曲线分析,AUC为0.74(95%CI:0.71～0.86)。结论:本研究基于年龄、皮疹反复≥4周、ALB降低、Cys-C升高和夹瘀证这5项独立危险因素,首次建立了预测HSPN发生风险的列线图模型,可定量评估肾脏受累风险,有助于HSPN的早期识别,更具临床实用性。
Objective: To screen out the risk factors for children with henoch-sch?nlein purpura nephritis(HSPN), and to establish a risk prediction nomogram model for HSPN. Methods: A total of 192 cases of HSPN were studied. The cases were divided into two groups according to the urine test results, HSPN group(59 cases) and NHSPN group(133 cases). The univariate and multivariate analysis were used to determine the risk factors and establish a nomogram. The areas under the ROC curve(AUC)were used to assess the clinical efficacy. Results: Age, persistent purpura≥4 weeks, ALB, Cys-C level incredsed and blood stasis syndrome were the independent risk factors for HSPN(P<0.05). The AUC for the nomogram model was 0.74(95%CI: 0.71～0.86).Conclusion: This study establishes the nomogram model for the first time, based on age, persistent purpura≥4 weeks, ALB, Cys-C level and blood stasis syndrome, which would provide a certain reference for the early identifying of HSPN quantitatively and can be more practical.
Objective: To screen out the risk factors for children with henoch-sch?nlein purpura nephritis(HSPN), and to establish a risk prediction nomogram model for HSPN. Methods: A total of 192 cases of HSPN were studied. The cases were divided into two groups according to the urine test results, HSPN group(59 cases) and NHSPN group(133 cases). The univariate and multivariate analysis were used to determine the risk factors and establish a nomogram. The areas under the ROC curve(AUC)were used to assess the clinical efficacy. Results: Age, persistent purpura≥4 weeks, ALB, Cys-C level incredsed and blood stasis syndrome were the independent risk factors for HSPN(P<0.05). The AUC for the nomogram model was 0.74(95%CI: 0.71～0.86).Conclusion: This study establishes the nomogram model for the first time, based on age, persistent purpura≥4 weeks, ALB, Cys-C level and blood stasis syndrome, which would provide a certain reference for the early identifying of HSPN quantitatively and can be more practical.
引文
[1]吴天慧,李志辉,段翠蓉,等.3482例小儿过敏性紫癜流行病学分析.实用预防医学,2014,21(8):978-980
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[11]赵国晓,马宏,杨娜娜,等.过敏性紫癜患儿早期肾损伤相关因素分析.世界最新医学信息文摘,2018,18(28):38-41
[12]刘丽君.92例过敏性紫癜患儿的临床特征及合并肾损害的危险因素分析.广西医科大学学报,2018,35(4):487-490
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[15]王芳,张迎辉.胱抑素C、纤维蛋白原及24h尿蛋白定量与紫癜性肾炎患儿肾脏病理分级的相关性研究.中国当代儿科杂志,2016,18(3):233-237
[16]Foster B J,Bernard C,Drummond K N,et al.Effective therapy for severe Henoch-Schonlein purpura nephritis with prednisone and azathioprine:A clinical and histopathologic study.J Pediatr,2000,136(3):370-375
[17]Dharnidharka V R,Kwon C,Stevens G.Serum cystatin C is superior to serum creatinine as a marker of kidney function:A meta-analysis.Am J Kidney Dis,2002,40(2):221-226
[18]徐坚,冯星,钱镜秋.血清半胱氨酸蛋白酶抑制剂C早期诊断紫癜性肾炎的价值.实用儿科临床杂志,2008,23(9):680-681
[19]王凤英,李晓忠,王兴东,等.肾小球内纤维蛋白原沉积在儿童过敏性紫癜性肾炎中的意义.临床儿科杂志,2018,36(3):182-187
[20]张龙真,黄岩杰,杨晓青,等.瘀血对过敏性紫癜患儿肾脏损伤的影响.中华中医药杂志,2017,32(8):3837-3839
[21]丁樱.《过敏性紫癜中医诊疗指南》第二轮专家问卷调查分析.中医学报,2011,26(25):70-71
[22]袭雷鸣,金喻,潘月丽.潘月丽治疗儿童紫癜性肾炎经验.湖南中医杂志,2016,32(2):38-45
[23]Gong Y,Ji P,Sun W,et al.Development and validation of nomograms for predicting overall and breast cancer-specific survival in young women with breast cancer:A population-based study.Transl Oncol,2018,11(6):1334-1342
[2]胡亚美,江载芳,申昆玲,等.诸福棠实用儿科学.8版.北京:人民卫生出版社,2015:773-775
[3]中华医学会儿科分会肾脏病学组.小儿肾小球疾病的临床分类、诊断及治疗.中华儿科杂志,2001,39(12):746-749
[4]国家中医药管理局.中医病证诊断疗效标准.ZY/T001.1-94.南京:南京大学出版社,1994:18-19
[5]苏树蓉.中医儿科学.北京:人民卫生出版社,2003:70-75
[6]刘松山.中药治疗过敏性紫癜临床评价方法探讨.中国新药杂志,2011,20(8):704-706
[7]韩冰红,常丽,苑天桐,等.过敏性紫癜中医症状分级量化标准的研究.中国中医药科技,2010,17(1):3-5
[8]Yang Y H,Hung C F,Hsu C R,et al.A nationwide survey on epidemiological characteristics of childhood Henoch-Sch?lein purpura in Taiwan.Rheumatology(Oxford),2005,44:618-622
[9]燕丽,王连心,艾青华,等.基于HIS2110例过敏性紫癜患者真实世界实效分析.中国中医基础医学杂志,2014,20(10):1374-1377
[10]Jauhola O,Ronkainen J,Koskimies O,et al.Renal manifestations of Henoch-Sch?nlein purpura in a 6-month prospective study of 223children.Arch Dis Child,2010,95(11):877-882
[11]赵国晓,马宏,杨娜娜,等.过敏性紫癜患儿早期肾损伤相关因素分析.世界最新医学信息文摘,2018,18(28):38-41
[12]刘丽君.92例过敏性紫癜患儿的临床特征及合并肾损害的危险因素分析.广西医科大学学报,2018,35(4):487-490
[13]Mao Y Y,Yin L,Huang H,et al.Henoch-Schonlein purpura in535 Chinese children:Clinical features and risk factors for renal involvement.J Inter Med Res,2014,42(4):1043-1049
[14]奚晓隽,鲍华英,黄松明,等.初发过敏性紫癜患儿肾脏受累危险因素分析.中国循证儿科杂志,2011,6(5):349-353
[15]王芳,张迎辉.胱抑素C、纤维蛋白原及24h尿蛋白定量与紫癜性肾炎患儿肾脏病理分级的相关性研究.中国当代儿科杂志,2016,18(3):233-237
[16]Foster B J,Bernard C,Drummond K N,et al.Effective therapy for severe Henoch-Schonlein purpura nephritis with prednisone and azathioprine:A clinical and histopathologic study.J Pediatr,2000,136(3):370-375
[17]Dharnidharka V R,Kwon C,Stevens G.Serum cystatin C is superior to serum creatinine as a marker of kidney function:A meta-analysis.Am J Kidney Dis,2002,40(2):221-226
[18]徐坚,冯星,钱镜秋.血清半胱氨酸蛋白酶抑制剂C早期诊断紫癜性肾炎的价值.实用儿科临床杂志,2008,23(9):680-681
[19]王凤英,李晓忠,王兴东,等.肾小球内纤维蛋白原沉积在儿童过敏性紫癜性肾炎中的意义.临床儿科杂志,2018,36(3):182-187
[20]张龙真,黄岩杰,杨晓青,等.瘀血对过敏性紫癜患儿肾脏损伤的影响.中华中医药杂志,2017,32(8):3837-3839
[21]丁樱.《过敏性紫癜中医诊疗指南》第二轮专家问卷调查分析.中医学报,2011,26(25):70-71
[22]袭雷鸣,金喻,潘月丽.潘月丽治疗儿童紫癜性肾炎经验.湖南中医杂志,2016,32(2):38-45
[23]Gong Y,Ji P,Sun W,et al.Development and validation of nomograms for predicting overall and breast cancer-specific survival in young women with breast cancer:A population-based study.Transl Oncol,2018,11(6):1334-1342