肾病综合征患儿和青年人群肺栓塞的患病率及相关危险因素：一项中国大样本队列研究。

Prevalence and Associated Risk Factors of Pulmonary Embolism in Children and Young Adults With Nephrotic Syndrome: A Chinese Large Cohort Study.

机构信息

Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu.

Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang, China.

出版信息

J Thorac Imaging. 2021 Sep 1;36(5):326-332. doi: 10.1097/RTI.0000000000000603.

DOI:10.1097/RTI.0000000000000603

PMID:34269751

Abstract

PURPOSE

Nephrotic syndrome (NS) is highly associated with an increased risk of pulmonary embolism (PE) in children and young adults. However, few studies have specified the risk factors of PE in children and young adults with NS. We sought to determine the prevalence and associated factors of PE confirmed with computed tomography pulmonary angiography in Chinese children and young adults with NS.

METHODS

Data from 444 children and young adults with NS who had computed tomography pulmonary angiography from December 2010 to October 2018 were retrospectively analyzed. The prevalence of PE was estimated for different age, sex, and histopathologic types of NS. Multivariable logistic regression was used to identify independent risk factors of PE in children and young adults with NS. Models incorporating the independent risk factors were evaluated using receiver operation characteristic curves. Area under the curve was used to determine the best-performing prognosticators for predicting PE.

RESULTS

There were 444 patients in the study cohort (310 male patients, 134 female patients; mean age 19±3 y; range: 6 to 25 y). PE was present in 24.8% of the participants (110 of 444, 18.2% female). Children and young adult NS patients with PE tend to be older, male, to have a previous thromboembolism history and smoking, and have a higher level of proteinuria, D-dimer, and serum albumin (P<0.05 for all). Children and young adults with membranous nephropathy are likely to have a higher incidence of PE than those with other types of nephropathy. Membranous nephropathy and proteinuria were significant predictors of PE in children and young adults with NS (P<0.05 for all). The area under the curves of each model for the presence of PE in children and young adults with NS based on biochemical parameters and clinical information (model 1), adjusted for proteinuria (model 2), and adjusted for membranous nephropathy (model 3) were 0.578, 0.657, and 0.709, respectively. Compared with model 1, model 2, and model 3 showed statistically significant differences (model 1 vs. model 2, P=0.0336; model 1 vs. model 3, P=0.0268). There was no statistically significant difference between model 2 and model 3 (P=0.2947).

CONCLUSION

This study identified membranous nephropathy and proteinuria as independent associated factors of PE in children and young adults with NS, which can be noted as a risk factor to guide clinician management in this population.

摘要

目的

肾病综合征（NS）与儿童和青年人群的肺栓塞（PE）风险增加高度相关。然而，很少有研究明确了 NS 儿童和青年人群中 PE 的危险因素。我们旨在确定在中国 NS 儿童和青年人群中，经计算机断层扫描肺动脉造影（CTPA）证实的 PE 的患病率和相关因素。

方法

回顾性分析了 2010 年 12 月至 2018 年 10 月期间接受 CTPA 的 444 例 NS 儿童和青年患者的数据。估计了不同年龄、性别和 NS 组织病理学类型的 PE 患病率。多变量逻辑回归用于确定 NS 儿童和青年人群中 PE 的独立危险因素。使用接收者操作特征曲线评估纳入独立危险因素的模型。曲线下面积用于确定预测 PE 的最佳预后指标。

结果

研究队列中有 444 例患者（310 例男性，134 例女性；平均年龄 19±3 岁；范围：6-25 岁）。参与者中有 24.8%（444 例中有 110 例，女性占 18.2%）存在 PE。患有 PE 的 NS 儿童和青年患者往往年龄较大、为男性、有血栓栓塞病史和吸烟史，且蛋白尿、D-二聚体和血清白蛋白水平较高（所有 P<0.05）。膜性肾病患者发生 PE 的几率高于其他类型肾病患者。膜性肾病和蛋白尿是 NS 儿童和青年患者发生 PE 的显著预测因子（所有 P<0.05）。基于生化参数和临床信息的 NS 儿童和青年人群中 PE 存在的每个模型的曲线下面积（模型 1）、调整蛋白尿（模型 2）和调整膜性肾病（模型 3）分别为 0.578、0.657 和 0.709。与模型 1 相比，模型 2 和模型 3 差异具有统计学意义（模型 1 与模型 2，P=0.0336；模型 1 与模型 3，P=0.0268）。模型 2 与模型 3 之间无统计学差异（P=0.2947）。