白蛋白-纤维蛋白原比值是 IgA 肾病患者糖皮质激素反应和预后的独立预测因子。
Albumin-to-fibrinogen ratio is an independent predictor of corticosteroid response and prognosis in patients with IgA nephropathy.
机构信息
Department of Nephrology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, No. 366 Taihu Road, Jiangsu, 225300, Taizhou, China.
出版信息
Eur J Med Res. 2023 Apr 3;28(1):146. doi: 10.1186/s40001-023-01106-6.
BACKGROUND
The objective of this study was to investigate whether the albumin-to-fibrinogen ratio (AFR) can predict corticosteroid response and prognosis prediction among IgA nephropathy (IgAN) patients.
METHODS
Eligible participants with diagnosed IgAN who were scheduled to receive corticosteroid therapy for persistent proteinuria were recruited. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of AFR or estimated glomerular filtration rate (eGFR) for corticosteroid response in IgAN patients. Risk factors for corticosteroid response and prognosis were validated using univariate and multivariate Cox proportional analyses.
RESULTS
AFR and eGFR were both effective predictors of corticosteroid response in IgAN patients, with area under the curve (AUC) values of 0.686 and 0.643, respectively (P < 0.001 and P = 0.002). Baseline AFR level at biopsy was an independent risk factor for remission after corticosteroid therapy (HR: 2.38, 95% CI 1.32-4.07, P = 0.015), 50% decline in eGFR (HR: 0.78, 95% CI 0.69-0.89, P = 0.025), kidney failure (HR: 2.46, 95%CI 1.16-3.71, P = 0.016), and a composite event (HR: 2.13, 95%CI 1.28-3.34, P = 0.009) in IgAN patients.
CONCLUSIONS
AFR level at biopsy was a potential predictor of corticosteroid response and prognosis among IgAN patients.
背景
本研究旨在探讨血清白蛋白与纤维蛋白原比值（AFR）能否预测 IgA 肾病（IgAN）患者对皮质类固醇的反应和预后。
方法
纳入了拟接受皮质类固醇治疗持续性蛋白尿的确诊为 IgAN 的患者。通过接受者操作特征（ROC）曲线分析，评估 AFR 或估算肾小球滤过率（eGFR）对 IgAN 患者皮质类固醇反应的预测价值。采用单因素和多因素 Cox 比例风险分析验证皮质类固醇反应和预后的危险因素。
结果
AFR 和 eGFR 均为 IgAN 患者皮质类固醇反应的有效预测因子，曲线下面积（AUC）值分别为 0.686 和 0.643（P<0.001 和 P=0.002）。活检时的基线 AFR 水平是皮质类固醇治疗后缓解的独立危险因素（HR：2.38，95%CI 1.32-4.07，P=0.015），eGFR 下降 50%（HR：0.78，95%CI 0.69-0.89，P=0.025）、肾衰竭（HR：2.46，95%CI 1.16-3.71，P=0.016）和复合事件（HR：2.13，95%CI 1.28-3.34，P=0.009）的独立危险因素。
结论
活检时的 AFR 水平是 IgAN 患者皮质类固醇反应和预后的潜在预测因子。
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