Department of Nephropathy, Affiliated Hospital of Qingdao University, 266003 Qingdao, Shandong, China.
Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, 266003 Qingdao, Shandong, China.
Discov Med. 2023 Aug;35(177):517-524. doi: 10.24976/Discov.Med.202335177.52.
Clinically, it has been observed that patients with idiopathic membranous nephropathy (IMN) have a higher probability of coronary heart disease. We aim to investigate the risk factors associated with coronary heart disease in IMN patients using a mechanomics approach and establish a clinical diagnosis model.
We collected sixty-nine clinical data points from patients undergoing phospholipase A2 receptor (anti-PLA2R) tests at the Affiliated Hospital of Qingdao University between July 9, 2019 and March 15, 2021. We excluded patients with cancer, hepatitis B, recent injuries or surgeries, and those under 18. Finally, 162 patients were considered for our study, which included 73 patients with coronary heart disease. The patients were split into test and validation groups at a 7:3 ratio. We utilized the Mann-Whitney U test for initial factor screening and the least absolute shrinkage and selection operator (LASSO) regression for further index screening. Eventually, the effectiveness of the clinical model was evaluated through visual statistical methods.
Age, lymphocyte count, the sum of high-density lipoprotein (HDL) and low-density lipoprotein (LDL), serum creatinine, and antithrombin III were risk factors for coronary heart disease in patients with idiopathic membranous nephropathy in a multivariate regression ( < 0.1). In the training group, 14 clinical features were finally screened by the LASSO regression, and the area under the curve (AUC) of the training group was 0.90 (95% CI 0.877-0.959), accuracy (ACC) was 0.85, sensitivity was 0.76, specificity was 0.91, and precision was 0.85. F1 scored 0.80. In the verification group, AUC was 0.84 (0.743-0.927), ACC was 0.80, sensitivity was 0.67, specificity was 0.87, precision was 0.75, and F1 scored 0.71. We then visualized them using a nomogram based on multivariate regression. The C index and clinical decision curve evaluated them. The C index was 83.8%, and the clinical decision curve was also excellent.
We've established an effective clinical prediction model for patients with IMN who also have coronary heart disease. This model holds significant potential for enhancing clinical decision-making.
临床上观察到特发性膜性肾病（IMN）患者发生冠心病的概率更高。本研究旨在采用力学组学方法探讨特发性膜性肾病患者发生冠心病的相关危险因素，并建立临床诊断模型。
收集 2019 年 7 月 9 日至 2021 年 3 月 15 日在青岛大学附属医院行磷脂酶 A2 受体（抗-PLA2R）检测的患者 69 例临床资料，排除合并肿瘤、乙型肝炎、近期外伤或手术及年龄<18 岁的患者，最终纳入 162 例特发性膜性肾病患者进行研究，其中冠心病患者 73 例。患者按 7∶3 分为训练组和验证组。采用 Mann-Whitney U 检验进行初步因素筛选，最小绝对收缩和选择算子（LASSO）回归进行进一步指标筛选，最后采用可视化统计方法评价临床模型的有效性。
多因素回归分析显示，年龄、淋巴细胞计数、高密度脂蛋白（HDL）与低密度脂蛋白（LDL）之和、血清肌酐、抗凝血酶Ⅲ是特发性膜性肾病患者发生冠心病的危险因素（<0.1）。在训练组中，LASSO 回归最终筛选出 14 项临床特征，训练组的曲线下面积（AUC）为 0.90（95%CI 0.877-0.959），准确性（ACC）为 0.85，敏感度为 0.76，特异度为 0.91，精确性为 0.85，F1 评分为 0.80。在验证组中，AUC 为 0.84（0.743-0.927），ACC 为 0.80，敏感度为 0.67，特异度为 0.87，精确性为 0.75，F1 评分为 0.71。然后我们基于多因素回归构建了一个列线图来可视化它们。C 指数和临床决策曲线对它们进行了评估。C 指数为 83.8%，临床决策曲线也表现出色。
本研究建立了特发性膜性肾病患者合并冠心病的有效临床预测模型，该模型有望提高临床决策水平。
