A Case-control Study On The Influencing Factors Of 87cases With Refractory Lupus Nephritis

Objective:The research explores the influencing factors of refractory lupus nephritis（RLN）and provides a theoretical basis for the early development of RLN prevention and control measures.Methods:In this study,a case-control study was applied,and 366 patients with LN diagnosed in Yijishan Hospital of Wannan Medical College from February 2012 to July 2017 were selected as the research object.The research divided patients into RLN and non-RLN groups（nRLN）based on the effectiveness of conventional induction regimens（cyclophosphamide and or mycophenolate mofetil combined with glucocorticoid）for 6 months.The research retrospectively collected the general demographic characteristics,clinical characteristics,physical examination and laboratory test indicators of the two groups of patients at the first admission.SPSS18.0 was used for single-factor analysis;R 3.4.3 was used for multi-factor analysis of Lasso logistic method,the variables were screened to obtain the influencing factors and a regression equation model was constructed.The area under the ROC curve was used for verifying the predictive value of the model.Results:Among the 366 patients with LN,87 patients with RLN accounted for23.77%.（1）General demographic characteristics:the 34 male patients with RLN included 15（44.12%）and 332 female patients with RLN included 72（21.69%）,indicating that the proportion of male patients with RLN was higher than that of female patients（?²=8.564,P=0.003）,males are higher than females;there is no difference in age,occupation,marital status and educational level between RLN and nRLN groups Academic significance(?²_age=3.606,P=0.324;?²_occupation=6.149,P=0.188;P_{marital status}=0.846;?²_{education level}=0.371,P=0.831).（2）Clinical features:The clinical characteristics analyzed in this study showed that the differences between the two groups were not statistically significant.SLEDAI score（Z=-0.513,P=0.312）,arthritis（?²=0.852,P=0.537）,rash（?²=0.012,P=0.913）,hair loss（?²=1.321,P=0.250）,oral ulcer（?²=0.938,P=0.333）,fever（?²=0.151,P=0.697）,thrombocytopenia（P=0.537）,leukopenia（?²=0.620,P=0.438）,headache（P=0.563）,hematuria（?²=0.450,P=0.502）.（3）Physical examination and laboratory test indicators:Compared with the nRLN group,the RLN group has statistically significant differences as follows:height（Z=-2.873,P=0.003）,lymphocyte count（Z=-2.572,P=0.011）,urea nitrogen（Z=-2.011,P=0.045）,creatinine（Z=-2.955,P=0.003）,low density lipoprotein（Z=-1.582,P=0.016）.The indicators with no statistically significant differences are as follows:body weight（t=-1.455,P=0.092）,BMI（t=-0.656,P=0.512）,systolic blood pressure（Z=-1.355,P=0.176）,diastolic blood pressure（Z=-0.813,P=0.416）,white blood cell count（Z=-0.945,P=0.345）,red blood cell count（Z=-1.657,P=0.097）,hemoglobin（Z=-1.174,P=0.240）,platelets（Z=-1.099,P=0.272）,neutrophil count（Z=-0.149,P=0.881）,NLR（Z=-1.262,P=0.210）,percentage of neutrophils（Z=-0.287,P=0.774）,hematocrit（Z=-1.557,P=0.120）,mean red blood cell volume（Z=-0.581,P=0.0.561）,red blood cell distribution width（Z=-1.373,P=0.170）,platelets Distribution width（Z=-1.139,P=0.255）;urine microalbumin（Z=-0.601,P=0.548）,urine white blood cell count（Z=-0.056,P=0.955）,urine red blood cell count（Z=-0.070,P=0.944）,tube type count（Z=-0.031,P=0.976）;total protein（t=1.484,P=0.139）,albumin（t=1.272,P=0.204）,globulin（t=0.326,P=0.745）,white ball ratio（Z=-0.709,P=0.478）,alanine aminotransferase（Z=-1.119,P=0.263）,aspartate aminotransferase（Z=-0.946,P=0.344）,glucose（t=0.164,P=0.870）,total cholesterol（t=-0.784,P=0.434）,triglyceride（t=-0.762,P=0.446）,high density fat Protein（t=-0.106,P=0.915）,complement C3（t=-0.411,P=0.681）,complement C4（t=-1.892,P=0.059）,C-reactive protein（t=-0.779,P=0.437）,IgA（Z=-0.546,P=0.585）,IgG（t=0.579,P=0.563）,IgM（Z=-0.867,P=0.386）,IgE（Z=-0.371,P=0.711）,Erythrocyte sedimentation rate（Z=-0.163,P=0.871）,24h urine protein（Z=-1.449,P=0.147）.（4）Multi-factor analysis:There are obvious correlations between some independent variables.In this study,the Lasso logistic method is used to screen the influencing factors and build the model.The results reveal that when the model is fitted to step 7;that is,six variables are included,the fitted regression model is best.At this time,the variables（estimated coefficients）that enter the model are demonstrated as follows:low-density lipoprotein（0.0484）,height（0.0064）,creatinine（0.0780）,urea nitrogen（0.0003）,female（-0.0295）and lymphocyte count（-0.0176）.The influencing factors above are applied to build a regression equation prediction model.The area under the ROC curve of the model’s predicted value is 0.732.The corresponding sensitivity at the optimal segmentation point is 74.47%,the specificity is 46.22%,and the accuracy is 77.87%.Conclusion:A certain percentage of individuals with LN have RLN,and the risk factors should be effectively controlled to actively prevent LN from developing into RLN;Male LN patients are at a higher risk of developing into RLN,so LN induction therapy should be individualized for gender;In routine blood biochemical indicators,baseline low-density lipoprotein and creatinine levels are the main risk factors that affect RLN,and active control of these factors is of great significance for reducing the risk of RLN;The combination of gender,height,lymphocyte count,low-density lipoprotein,creatinine,and urea nitrogen has specific predictive value for RLN,which is conducive to the early diagnosis and monitoring of RLN.