Factors Affecting Glomerular Microthrombosis In Patients With Lupus Nephriti And Establishing A Diagnostic Model

Objective: To explore factors affecting glomerular microthrombosis in patients with lupus nephriti and establishing a diagnostic model.Methods: A retrospective analysis of 109 patients with LN diagnosed by renal biopsy at Shenzhen Second People's Hospital from January 1,2010 to April 30,2018.According to the standard of Napa,a total of 100 patients with LN were included in the study.GMT formation group(GMT group)and GMT-free group(Non-GMT group)were classified according to whether or not there was Glomerular microthrombosis(GMT)formation.The demographics,clinical pathological parameters and prognosis of the two groups were compared.Single factor and multivariate logistic regression analysis were used to explore the independent influencing factors of GMT formation.Kaplan-Meier survival curves and multivariate COX regression analysis were used to investigate the phase of GMT and lupus nephritis in renal endpoint events.Based on the conventional clinical indicators affecting the formation of GMT,a joint diagnosis model of GMT formation was established by ROC curve,and a line graph was produced.Results:(1)Clinical and pathological data: 100 patients with LN(94 women),33 patients(3 women)in the GMT group,and 67 patients(62 women)in the Non-GMT group.Compared with the Non-GMT group,patients with lupus nephritis with glomerular microthrombus were older(P=0.021),higher proportion of hypertension(P=0.032),and increased 24-hour total protein and serum uric acid levels.(P<0.05),ds DNA positive rate was higher(P<0.05),hemoglobin,serum albumin,serum C3,e GFR and other levels were lower.Among the 100 patients with LN,the GMT group was more common in lupus nephritis type IV,accounting for 25 cases(75.76%),and the remaining 8 cases(24.24%)were distributed in lupus nephritis IV+V type.Compared with the Non-GMT group,the GMT group had a higher proportion of total crescent,nuclear fragmentation,platinum ear,and endothelial proliferation,and mesangial cells and stromal hyperplasia and interstitial inflammatory cell infiltration were more severe(P<0.05).<0.05).(2)Univariate logistic regression analysis: hemoglobin,lymphocytes,e GFR,serum C3 may be protective factors for glomerular microthrombus formation,age,hypertension,24-hour urine protein quantitation,blood uric acid,anti-ds DNA,lupus activity Scoring,platinum ear,nuclear fragmentation,and interstitial inflammatory cell infiltration may be risk factors for glomerular microthrombus formation during renal biopsy.(3)Multivariate logistic regression analysis: hemoglobin and serum C3 were independent factors affecting glomerular microthrombus formation during renal biopsy.(4)Kaplan-Meier survival curve analysis: glomerular microthrombus is an independent risk factor for the progression of lupus nephritis.(5)Combined diagnosis model: Through multi-factor unconditional logistic analysis of clinical indicators,it was found that age,24-hour urine protein quantitation,lymphocytes,hemoglobin,and serum complement C3 were independent influencing factors of glomerular microthrombus formation..A diagnostic model of glomerular microthrombus formation was established by age,24-hour urine protein quantitation,lymphocytes,hemoglobin,and serum complement C3.The ROC curve found that the hemoglobin level predicted the area under the ROC curve of the glomerular microthrombus was 0.8756,the sensitivity was 0.7879,and the specificity was 0.833.The ROC curve suggests that age,24-hour urine protein quantitation,lymphocyte,hemoglobin,and serum complement C3 combined with the diagnosis of glomerular microthrombus formation have clinical significance,and the above-mentioned indicators are used to establish a line graph.Conclusion:(1)Patients with lupus nephritis with glomerular microthrombotic disease have more serious clinical manifestations and pathological manifestations.(2)Hemoglobin and serum C3 are independent influencing factors of glomerular microthrombus formation during renal biopsy.(3)Glomerular microthrombus is a risk factor for the progression of lupus nephritis.(4)Clinically,the age of patients with lupus nephritis should be clarified.24-hour urine protein quantitation,blood routine,serum complement C3 level examination in patients with lupus nephritis,and the risk of glomerular microthrombus formation by line-column screening The population reduces the formation of glomerular microthrombus by using anticoagulant drugs,antiplatelets and other drugs for these dangerous people.