Department of Nephrology, HeBei General Hospital, ShiJiaZhuang, China.
Department of Dermatology, the 4th Affiliated Hospital of HeBei Medical University, ShiJiaZhuang, China.
Nephrology (Carlton). 2019 Oct;24(10):1009-1016. doi: 10.1111/nep.13544. Epub 2019 Apr 29.
Pulmonary infection (PI) is the leading cause of death in patients with primary membranous nephropathy on immunosuppressive therapy. A rating score was thus developed to foresee the risk of PI in such patients.
We reviewed the charts of the pertinent patients treated during the past 3 years either with (n = 29) or without PI (n = 304). Clinical and laboratory data, the usage of cyclosporin A (CysA), and occurrence of PI were recorded. Cox regression analysis and receiver operating characteristic (ROC) curve were respectively used to identify the risk factors and assess their clinical relevance.
The incidence of PI was 8.7% at 82.1 ± 20.9 days after the initiation of CysA regimen with a male predominance superimposed on smoking. Factors associated with PI were immunoglobulin G titer (hazard ratio = 4.56, 95% confidence interval = 2.31-8.95), plasma CysA concentration (3.71, 1.87-6.18), serum creatinine level (2.57, 1.31-5.82), CD4 /CD8 ratio (2.36, 1.26-6.06) and plasma albumin content (1.53, 1.05-3.25). These five factors, along with the male gender and smoking status, were granted different ratings after examined by the ROC curve and constituted the anticipating pulmonary infection in primary membranous nephropathy receiving CysA (AIM-7C) score. Accordingly, the respective percent composition of the infection and non-infection group was 0, 11.1%, 72.2%, 16.7% and 91.7%, 8.3%, 0, 0 in the order of low, moderate, high and utmost risk. Furthermore, eight new cases of PI were successfully predicted.
Our AIM-7C score may therefore help to predict the onset and facilitate the prevention of PI, a potentially life-threatening complication of the immunosuppressive therapy.
肺部感染（PI）是接受免疫抑制治疗的原发性膜性肾病患者死亡的主要原因。因此，开发了一种评分系统来预测此类患者发生 PI 的风险。
我们回顾了过去 3 年中接受治疗的相关患者的图表，这些患者分为接受（n=29）或未接受 PI（n=304）治疗的两组。记录了临床和实验室数据、环孢素 A（CysA）的使用情况以及 PI 的发生情况。使用 Cox 回归分析和接收者操作特征（ROC）曲线分别识别风险因素并评估其临床相关性。
PI 的发生率为 8.7%，在开始 CysA 方案后 82.1±20.9 天发生，男性占优势，且伴有吸烟。与 PI 相关的因素包括免疫球蛋白 G 滴度（危险比=4.56，95%置信区间=2.31-8.95）、血浆 CysA 浓度（3.71，1.87-6.18）、血清肌酐水平（2.57，1.31-5.82）、CD4/CD8 比值（2.36，1.26-6.06）和血浆白蛋白含量（1.53，1.05-3.25）。这五个因素，以及男性性别和吸烟状况，经过 ROC 曲线检查后被赋予不同的评分，并构成了接受 CysA 治疗的原发性膜性肾病的预测肺部感染（AIM-7C）评分。相应地，感染组和非感染组的百分比构成为低危、中危、高危和极高危分别为 0、11.1%、72.2%、16.7%和 91.7%、8.3%、0、0。此外，成功预测了 8 例新的 PI 病例。
因此，我们的 AIM-7C 评分可能有助于预测发病并促进 PI 的预防，PI 是免疫抑制治疗潜在的危及生命的并发症。
