| Objectives:This study explored the risk factors of renal insufficiency in patients with Ig A nephropathy（Ig AN）and constructed a clinical prediction model to provide a basis for the early diagnosis of Ig AN.Methods:A total of 693 patients with pathologically diagnosed Ig AN in the First Hospital of Jilin University from March 2013 to October 2021 were retrospectively analyzed.The patients were divided into normal renal function group（n=288）and renal insufficiency group（n=405）by estimated glomerular filtration rate（e GFR）.Using R language programming software,the training set and the validation set were distributed in a ratio of 7:3,and the variables with a missing data ratio of less than 30% were filled with multiple imputation methods.In the training set,univariate logistic regression was used to screen the variables of renal insufficiency in Ig AN patients,and multivariate logistic regression,lasso regression,stepwise regression and random forest methods were used to construct prediction models for the selected variables.10-fold crossvalidation,Hosmer-Lemeshow test,Area Under the Receiver Operating Characteristic Curve（AUC）,Calibration curve and Decision curve analysis（DCA）were used to evaluate the predictive performance of the model,and test the predictive performance in the validation set.Results:1.Among the 693 patients with Ig AN,there were 356 males and 337 females,405 patients with renal insufficiency,accounting for 58.4% of the total,and 238 patients with a history of hypertension,accounting for 34.3%,and the pathological Lee grade was above grade III.273 cases,accounting for 39.4%.2.In univariate logistic regression,age,red blood cell count,hemoglobin count,neutrophil count,retinol binding protein,platelet count,neutrophil/lymphocyte ratio,blood urea nitrogen,uric acid,cystatin C,glycerol Triesters,C3,IGA/C3,free T3,erythrocyte sedimentation rate,urinary Ig G,systolic blood pressure,diastolic blood pressure,mean arterial pressure,history of hypertension,Lee grade>III,urine protein>1g/24 h and other 22 factors,were evaluated by 22 factors.Risk factors for renal insufficiency in Ig AN patients were included.3.Among the three models constructed,age,blood urea nitrogen,uric acid,elevated cystatin C and Lee grade>III were included in all models.Among them,the model 1 constructed by ordinary Logistic regression method included 8 factors including age,red blood cell count,blood urea nitrogen,uric acid,cystatin C,C3,free T3,and Lee grade > III;The variables are the same,and 8 factors including age,red blood cell count,blood urea nitrogen,uric acid,cystatin C,C3,diastolic blood pressure,and Lee grade > III are included,which is model 2;Five factors including blood urea nitrogen,uric acid,cystatin C,and Lee grade > III were included,which was model 3.4.The three established models perform well in both the training set and the validation set,with high discrimination and calibration,and good prediction performance.The same factors of age,blood urea nitrogen,uric acid,cystatin C and Lee grade>III in the three models are also all factors included in model 3,so model 3is used as the final model of this study.Conclusions:1.Age,blood urea nitrogen,uric acid,elevated cystatin C and Lee grade>III were independent risk factors for renal insufficiency in Ig AN patients.Older age,higher uric acid,blood urea nitrogen,and cystatin C levels,and greater risk of renal insufficiency in pathological Lee grade III or higher.2.Ig AN patients with normal renal function and renal insufficiency had significant differences between S1 and T1-2,and glomerulosclerosis and renal interstitial damage were considered as risk factors for renal insufficiency.And the higher the levels of cystatin C and uric acid,the more serious the renal interstitial damage.3.The predictive model constructed by five factors including age,blood urea nitrogen,uric acid,cystatin C,and Lee grade>III has predictive value for the occurrence of renal insufficiency in Ig AN patients,and provides a basis for clinical diagnosis and treatment. |
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