Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
953th Hospital, Shigatse Branch, Army Medical University (Third Military Medical University), Shigatse, China.
Biomed Eng Online. 2023 Feb 2;22(1):6. doi: 10.1186/s12938-023-01063-5.
The diagnosis of primary membranous nephropathy (PMN) often depends on invasive renal biopsy, and the diagnosis based on clinical manifestations and target antigens may not be completely reliable as it could be affected by uncertain factors. Moreover, different experts could even have different diagnosis results due to their different experiences, which could further impact the reliability of the diagnosis. Therefore, how to properly integrate the knowledge of different experts to provide more reliable and comprehensive PMN diagnosis has become an urgent issue.
This paper develops a belief rule-based system for PMN diagnosis. The belief rule base is constructed based on the knowledge of the experts, with 9 biochemical indicators selected as the input variables. The belief rule-based system is developed of three layers: (1) input layer; (2) belief rule base layer; and (3) output layer, where 9 biochemical indicators are selected as the input variables and the diagnosis result is provided as the conclusion. The belief rule base layer is constructed based on the knowledge of the experts. The final validation was held with gold pattern clinical cases, i.e., with known and clinically confirmed diagnoses.
134 patients are used in this study, and the proposed method is defined by its sensitivity, specificity, accuracy and area under curve (AUC), which are 98.0%, 96.9%, 97.8% and 0.93, respectively. The results of this study present a novel and effective way for PMN diagnosis without the requirement of renal biopsy.
Through analysis of the diagnosis results and comparisons with other methods, it can be concluded that the developed system could help diagnose PMN based on biochemical indicators with relatively high accuracy.
原发性膜性肾病（PMN）的诊断通常依赖于有创性的肾活检，而基于临床表现和靶抗原的诊断可能并不完全可靠，因为它可能受到不确定因素的影响。此外，由于经验不同，不同的专家甚至可能得出不同的诊断结果，这可能进一步影响诊断的可靠性。因此，如何正确整合不同专家的知识，提供更可靠、更全面的 PMN 诊断已成为当务之急。
本文开发了一种基于置信规则的 PMN 诊断系统。置信规则库基于专家知识构建，选择 9 个生化指标作为输入变量。置信规则基系统由三层组成：（1）输入层；（2）置信规则库层；（3）输出层，其中选择 9 个生化指标作为输入变量，提供诊断结果作为结论。置信规则库层基于专家知识构建。最终的验证采用金标准临床病例进行，即具有已知和临床确诊的诊断。
本研究共纳入 134 例患者，该方法的定义为其灵敏度、特异性、准确性和曲线下面积（AUC），分别为 98.0%、96.9%、97.8%和 0.93。本研究的结果为 PMN 诊断提供了一种新颖而有效的方法，无需进行肾活检。
通过对诊断结果的分析和与其他方法的比较，可以得出结论，该开发的系统可以帮助基于生化指标以相对较高的准确性诊断 PMN。
