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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

邮发代号 80-967

2019 Impact Factor: 3.421

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Frontiers of Medicine  2019, Vol. 13 Issue (5): 618-625   https://doi.org/10.1007/s11684-018-0620-5
  本期目录
Comparative analysis of membranous and other nephropathy subtypes and establishment of a diagnostic model
Hanyu Zhu1, Bo Fu1, Yong Wang1(), Jing Gao2, Qiuxia Han3, Wenjia Geng1, Xiaoli Yang1, Guangyan Cai1, Xiangmei Chen1, Dong Zhang1()
1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing Key Laboratory of Kidney Disease, Beijing 100853, China
2. Department of Clinical Biochemistry, Chinese PLA General Hospital, Beijing 100853, China
3. Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Abstract：

This study aimed to compare clinical features between membranous nephropathy (MN) and nonmembranous nephropathy (non-MN), to explore the clinically differential diagnosis of these two types, and to establish a diagnostic model of MN. After renal biopsy was obtained, 798 patients were divided into two groups based on their examination results: primary MN group (n = 248) and non-MN group (n = 550). Their data were statistically analyzed. Logistic regression analysis indicated that anti-PLA2R antibodies, IgG, and Cr were independently correlated with MN, and these three parameters were then used to establish the MN diagnostic model. A receiver operating characteristic (ROC) curve confirmed that our diagnostic model could distinguish between patients with and without MN, and their corresponding sensitivity, specificity, and AUC were 79.9%, 89.4%, and 0.917, respectively. The cutoff value for this combination in MN diagnosis was 0.34. The established diagnostic model that combined multiple factors shows a potential for broad clinical applications in differentiating primary MN from other kidney diseases and provides reliable evidence supporting the feasibility of noninvasive diagnosis of kidney diseases.
Key words： multiparameter analysis    diagnosis    model    membranous nephropathy
收稿日期: 2017-06-27      出版日期: 2019-10-14
Corresponding Author(s): Yong Wang,Dong Zhang   
 引用本文:   
. [J]. Frontiers of Medicine, 2019, 13(5): 618-625.
Hanyu Zhu, Bo Fu, Yong Wang, Jing Gao, Qiuxia Han, Wenjia Geng, Xiaoli Yang, Guangyan Cai, Xiangmei Chen, Dong Zhang. Comparative analysis of membranous and other nephropathy subtypes and establishment of a diagnostic model. Front. Med., 2019, 13(5): 618-625.
 链接本文:  
https://academic.hep.com.cn/fmd/CN/10.1007/s11684-018-0620-5
https://academic.hep.com.cn/fmd/CN/Y2019/V13/I5/618
Index full name Abbreviation Reference range
Anti-phospholipase A2 receptor antibodies Anti-PLA2R antibodies 0−20 RU/mL
Alanine aminotransferase ALT 0−40 U/L
Aspartate aminotransferase AST 0−40 U/L
Total protein TP 55−80 g/L
Albumin ALB 35−50 g/L
Total bilirubin TB 0−21 mmol/L
Direct bilirubin DB 0−8.6 mmol/L
Alkaline phosphatase ALP 0−130 U/L
g-Glutamyltransferase GGT 0−50 U/L
Glucose GLU 3.4−6.2 mmol/L
Urea nitrogen UN 1.8−7.5 mmol/L
Creatinine Cr 30−110 mmol/L
Uric acid Ua 104−444 mmol/L
Total cholesterol CH 3.1−5.7 mmol/L
Triglyceride TG 0.4−1.7 mmol/L
Creatine kinase CK 2−200 U/L
Lactate dehydrogenase LDH 40−250 U/L
High-density lipoprotein cholesterol HDL 1−1.6 mmol/L
Low-density lipoprotein cholesterol LDL 0−3.4 mmol/L
Thrombin time TT 16.0−18.0 s
Prothrombin time PT 11.0−15.0 s
Plasma fibrinogen FIB 200−400 mg/dL
D-dimer D2 0.0−0.5 mg/L
Immunoglobulin A IgA 70−180 mg/dL
Immunoglobulin G IgG 700−1600 mg/dL
Immunoglobulin M IgM 40−230 mg/dL
Immunoglobulin E IgE 0−100 IU/mL
Complement 3 C3 90−180 mg/dL
Complement 4 C4 10−40 mg/dL
Body mass index BMI 18.5−24.99
Activated partial thromboplastin time APTT 30−45 s
Prothrombin activity PTA 70%−150%
Tab.1  
Clinicopathologic features Number of cases (n, %) MN group (n, %) Non-MN group (n, %) c2 P value
Total 798 (100) 248 (31.08) 550 (68.92)
Age (year) 49.115 0.000
<45 464 (58.15) 99 (39.91) 365 (66.36)
≥45 334 (41.85) 149 (60.09) 185 (33.64)
Hypertension 13.537 0.000
Yes 370 (46.37) 91 (36.69) 279 (50.73)
No 428 (53.63) 157 (63.31) 271 (49.27)
Gender 1.714 0.190
Male 487 (61.03) 143 (57.66) 344 (65.55)
Female 311 (38.97) 105 (42.34) 206 (37.45)
Diabetes 1.562 0.211
Yes 115 (14.41) 30 (12.10) 85 (15.45)
No 683 (85.59) 218 (87.90) 465 (84.55)
NS 154.875 0.000
Yes 311 (38.97) 176 (70.97) 135 (24.55)
No 487 (61.03) 72 (29.03) 415 (75.45)
IgAN 164.466 0.000
Yes 280 (35.09) 7 (2.82) 273 (49.64)
No 518 (64.91) 241 (97.18) 277 (50.36)
Tab.2  
Parameter Mean±SD
MN group non-MN group
BMI 25.89±4.69 25.22±4.23
Anti-PLA2R antibodies 97.56±183.78** 2.73±8.75
ALT (U/L) 21.05±16.64 23.69±25.27
AST (U/L) 18.53±9.06 19.13±12.13
TP (g/L) 49.36±9.94* 61.07±11.70
ALB (g/L) 26.98±6.99* 36.10±8.90
TB (mmol/L) 7.77±3.57* 8.96±4.63
DB (mmol/L) 1.49±1.15* 2.16±1.33
ALP (U/L) 58.95±16.55* 69.50±36.20
GGT (U/L) 35.42±48.55 33.97±55.55
GLU (mmol/L) 4.91±1.21 4.98±1.90
UN (mmol/L) 5.21±2.41** 6.83±3.97
Cr (mmol/L) 75.86±25.93** 115.20±75.14
Ua (mmol/L) 345.78±95.38 374.43±104.02
CH (mmol/L) 7.08±2.33 5.38±2.23
TG (mmol/L) 2.54±1.86 2.09±1.38
CK (U/L) 101.31±135.22 93.31±76.94
LDH (U/L) 194.79±58.53 179.47±59.33
HDL (mmol/L) 1.45±0.52 1.22±0.95
LDL (mmol/L) 4.86±2.02* 3.55±1.86
TT (s) 17.24±1.62 16.43±1.52
APTT 36.27±5.99 37.45±4.61
PT (s) 12.96±2.10 13.21±1.16
PTA 107.92±15.88 100.74±13.56
Serum fibrinogen 4.88±1.49 4.03±1.49
D2 (mg/L) 1.28±2.32* 0.86±1.48
IgA (mg/dL) 215.11±84.46* 276.09±123.41
IgG (mg/dL) 622.33±280.82** 935.78±380.02
IgM (mg/dL) 115.39±77.72 112.30±139.87
IgE (IU/mL) 124.77±187.59** 262.64±1071.52
C3 (mg/dL) 113.95±24.64 105.47±26.91
C4 (mg/dL) 27.99±9.68 25.91±9.40
Tab.3  
Fig.1  
B S.E. Wald df Sig. Exp (B) 95% CI for EXP(B)
Lower Upper
Anti-PLA2R antibodies 0.080 0.014 32.146 1 0.000 1.083 1.054 1.113
Cr -0.030 0.005 38.813 1 0.000 0.971 0.962 0.980
IgG -0.002 0.000 30.439 1 0.000 0.998 0.998 0.999
Constant 2.290 0.477 23.043 1 0.000 9.872
Tab.4  
Fig.2  
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