儿童原发性肾病综合征复发相关因素分析及风险预测模型构建

doi:10.12372/jcp.2023.23e0209

Abstract

Abstract:

Objective To explore the related factors of recurrence and to construct a risk prediction model in children with primary nephrotic syndrome (PNS). Methods The clinical data of children diagnosed with PNS from January 2013 to January 2020 were retrospectively analyzed. The recurrence of PNS children was followed up, the risk factors affecting recurrence and frequent recurrence were analyzed, the prediction model was established and its efficacy was evaluated. Results A total of 392 children with PNS (192 boys and 200 girls) were included and the median age was 8.0(7.0-10.0) years old. Among the 392 children, 266 (67.9%) had recurrence and 124 (46.6%) had frequent recurrence. Multivariate logistic regression analysis showed that the increase of onset age was an independent protective factor for the recurrence of PNS (P<0.05), and nephritis type and the prolonged time of urinary protein turning negative were independent risk factors for the recurrence of PNS (P<0.05). The regression equation was as follows: Logit (P)= -14.27-1.85× (onset age) +0.65× (clinical type) +1.71× (negative conversion time of urine protein), and the area under the receiver operating characteristic (ROC) curve (AUC) by the model was 0.90 (95%CI: 0.88-0.93). Poor compliance and poor parents' understanding of PNS were independent risk factors for frequent recurrence of PNS (P<0.05), and prolonged first recurrence time was an independent protective factor for frequent recurrence of PNS (P<0.05). The regression equation was as follows: Logit (P)= -0.52+0.54×(compliance)+0.51× (parental cognition to PNS) -0.09 × (first recurrence time), and the AUC predicting frequent recurrence in children with PNS was 0.89 (95%CI: 0.86-0.92). Conclusions The overall recurrence rate of PNS children is high, which is closely related to the age of onset, nephritis type and negative conversion time of urine protein, while children's compliance, parental cognition to PNS and first recurrence time are related to frequent recurrence. Targeted intervention measures should be given to reduce the recurrence rate of children.

Key words: primary nephrotic syndrome, recurrence, frequent recurrence, prediction model

ZHENG Zhifang, JING Xiaoqing, LIU Lirui, WANG Wentao. Related factors analysis of recurrence and risk prediction model construction for primary nephrotic syndrome in children[J].Journal of Clinical Pediatrics, 2023, 41(12): 914-918.

Figures/Tables 3

临床资料	复发组 (n=266)	未复发组 (n=126)	统计量	P	频复发组 (n=124)	非频复发组 (n=142)	统计量	P
年龄($\bar{x} \pm s$)/岁	8.5±1.0	8.6±0.9	t=0.69	0.491	8.5±0.9	8.6±1.0	t=0.61	0.545
性别(男/女)	128/138	64/62	χ²=0.25	0.621	61/63	67/75	χ²=0.11	0.743
居住地为城市[n(%)]	142(53.4)	72(57.1)	χ²=0.49	0.485	64(51.6)	78(54.9)	χ²=0.29	0.589
发病年龄($\bar{x} \pm s$)/岁	3.4±0.5	3.8±0.6	t=7.48	<0.001	3.4±0.5	3.5±0.4	t=1.03	0.304
临床分型[n(%)]			χ²=12.22	<0.001			χ²=1.06	0.304
单纯型	152(57.1)	95(75.4)			75(60.5)	77(54.2)
肾炎型	114(42.9)	31(24.6)			49(39.5)	65(45.8)
依从性良好[n(%)]	215(80.8)	112(88.9)	χ²=4.02	0.045	93(75.0)	122(85.9)	χ²=5.09	0.024
家长PNS疾病了解[n(%)]			χ²=13.45	0.001			χ²=6.41	0.041
好	34(12.8)	35(27.8)			11(8.9)	23(16.2)
一般	98(36.8)	41(32.5)			41(33.1)	57(40.1)
差	134(50.4)	50(39.7)			72(58.1)	62(43.7)
总蛋白($\bar{x} \pm s$)/mg·L^-1	39.8±4.5	40.5±5.0	t=1.42	0.157	39.6±4.3	40.0±4.9	t=0.87	0.388
白蛋白($\bar{x} \pm s$)/mg·L^-1	17.2±3.1	17.3±2.9	t=0.30	0.762	17.1±3.0	17.3±3.2	t=0.40	0.692
白细胞计数($\bar{x} \pm s$)/×10⁹·L^-1	9.2±1.5	9.4±1.2	t=1.02	0.307	9.2±1.7	9.3±1.4	t=0.32	0.752
CRP($\bar{x} \pm s$)/mg·L^-1	18.4±2.2	18.2±2.8	t=1.01	0.315	18.5±2.4	18.3±2.1	t=0.67	0.487
血肌酐($\bar{x} \pm s$)/μmol·L^-1	32.5±3.5	32.9±3.2	t=1.08	0.279	32.5±3.6	32.4±3.2	t=0.26	0.792
血尿素氮($\bar{x} \pm s$)/mmol·L^-1	4.5±0.8	4.5±0.7	t=0.24	0.808	4.6±0.8	4.5±0.8	t=0.14	0.886
总胆固醇($\bar{x} \pm s$)/mmol·L^-1	8.7±1.8	8.8±2.0	t=0.35	0.729	8.8±1.7	8.7±1.9	t=0.50	0.618
三酰甘油($\bar{x} \pm s$)/mmol·L^-1	3.2±0.7	3.1±0.6	t=0.99	0.321	3.1±0.7	3.2±0.7	t=0.24	0.809
IgA($\bar{x} \pm s$)/g·L^-1	1.3±0.3	1.2±0.4	t=0.79	0.428	1.3±0.4	1.3±0.3	t=0.96	0.338
IgM($\bar{x} \pm s$)/g·L^-1	1.5±0.3	2.0±0.5	t=12.57	<0.001	1.4±0.3	1.5±0.4	t=0.88	0.381
IgG($\bar{x} \pm s$)/g·L^-1	2.2±0.6	2.1±0.6	t=0.92	0.361	2.2±0.5	2.2±0.7	t=1.21	0.227
24 h尿蛋白定量($\bar{x} \pm s$)/ mg·kg^-1	128.1±15.7	107.3±11.9	t=13.19	<0.001	131.4±17.2	125.3±15.2	t=3.07	0.002
尿蛋白转阴时间($\bar{x} \pm s$)/d	14.7±2.5	8.4±1.4	t=26.32	<0.001	16.3±2.6	13.2±2.3	t=10.66	<0.001
输注白蛋白[n(%)]	50(18.8)	26(20.6)	χ²=0.19	0.667	22(17.7)	28(19.7)	χ²=0.17	0.681
初次复发时间($\bar{x} \pm s$)/月	-	-	-	-	5.5±1.2	9.9±2.3	t=10.66	<0.001

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因素	偏回归系数	标准误	χ²值	OR(95%CI)	P
发病年龄	-1.85	0.49	13.96	0.16(0.06~0.42)	<0.001
临床分型为肾炎	0.65	0.32	4.14	1.91(1.02~3.55)	0.042
依从性为良好	-0.17	0.66	0.07	0.84(0.23~3.08)	0.794
家长PNS疾病了解情况为差	0.19	0.35	5.34	1.20(0.60~2.41)	0.602
IgM	-0.01	0.05	5.34	0.99(0.90~1.10)	0.878
24h尿蛋白定量	0.10	0.09	5.34	1.11(0.93~1.31)	0.242
尿蛋白转阴时间	1.71	0.21	5.34	5.52(3.67~8.30)	<0.001
常量	-14.27	3.50	16.62	－	<0.001

因素	偏回归系数	标准误	χ²值	OR(95%CI)	P
依从性不良	0.54	0.23	5.65	1.71(1.10~2.66)	0.018
家长PNS疾病了解情况差	0.51	0.22	5.34	1.66(1.08~2.55)	0.021
24 h尿蛋白定量	0.88	0.50	2.99	2.36(0.89~6.23)	0.085
尿蛋白转阴时间	1.11	0.59	3.58	3.04(0.96~9.60)	0.059
初次复发时间	-0.09	0.05	4.36	0.91(0.83~0.99)	0.037
常量	-0.52	0.14	13.80	－	<0.001

Related factors analysis of recurrence and risk prediction model construction for primary nephrotic syndrome in children

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