背景:确定具有肾脏意义的单克隆丙种球蛋白病(MGRS)的患者与没有MGRS但具有单克隆丙种球蛋白病和伴随肾脏疾病的患者至关重要。然而,很少有样本量大的研究,他们的发现是不一致的。本研究旨在对MGRS进行荟萃分析,以描述MGRS的一般特征及其预测因素。
方法:截至2022年12月发表的与MGRS临床病理特征相关的队列或病例对照研究从PubMed检索,科克伦图书馆,WebofScience,Scopus,和Embase数据库。两名研究人员搜索了符合纳入标准的研究。在单变量分析中,使用固定效应或随机效应模型来获得风险因素的加权均差(WMD)和比值比(OR)的汇总估计值.在多变量分析中,在转换了最初的估计值后,对每项研究的独立危险因素的OR进行汇总.
结果:荟萃分析包括6项研究。单因素分析显示MGRS中以下变量有统计学意义:年龄(WMD=1.78,95CI0.21-3.35),高血压(OR=0.54,95CI0.4-0.73),糖尿病(OR=0.42,95CI0.29-0.59),白蛋白(WMD=-0.26,95CI-0.38--0.14),尿蛋白水平(WMD=0.76,95CI0.31-1.2),尿蛋白≥1.5g/d(OR=1.98,95CI1.46-2.68),λ链价值(WMD=29.02,95CI16.55-41.49),异常游离轻链比例(OR=4.16,95CI1.65-10.47),骨髓穿刺率(OR=5.11,95%CI1.31-19.95),异常骨髓转归率(OR=9.63,95CI1.98~46.88)。多因素分析显示尿蛋白≥1.5g/d(OR=2.80,95CI1.53-5.15)和游离轻链比例异常(OR=6.98,95CI4.10-11.91)与MGRS的预测因素相关。
结论:与非MGRS患者的单克隆丙种球蛋白病和合并肾脏疾病相比,MGRS患者年龄较大,有较少的潜在疾病,更多的尿蛋白,更不正常的游离轻链比例,和更多异常的骨髓结果。尿蛋白≥1.5g/d和游离轻链比例异常是MGRS的独立危险因素。
BACKGROUND: It is crucial to identify patients with monoclonal gammopathy of renal significance (MGRS) from those without MGRS but with monoclonal gammopathy and concomitant kidney diseases. However, there have been few studies with large sample sizes, and their findings were inconsistent. This study aimed to conduct a meta-analysis of MGRS to describe the general characteristics of MGRS and its predictive factors.
METHODS: Cohort or case-control studies published through December 2022 and related to clinicopathological features of MGRS were retrieved from the PubMed, Cochrane Library, Web of Science, Scopus, and Embase databases. Two researchers searched for studies that met the inclusion criteria. In the univariate analysis, fixed- or random- effects models were used to obtain pooled estimates of the weighted mean difference (WMD) and odds ratio (OR) for risk factors. In the multivariate analysis, the ORs of the independent risk factors from each study were pooled after transforming the original estimates.
RESULTS: The meta-analysis included six studies. Univariate analysis showed that the following variables were statistically significant in MGRS: age (WMD = 1.78, 95%CI 0.21-3.35), hypertension (OR = 0.54, 95%CI 0.4-0.73), diabetes (OR = 0.42, 95%CI 0.29-0.59), albumin (WMD = - 0.26, 95%CI - 0.38--0.14), urinary protein level (WMD = 0.76, 95%CI 0.31-1.2), urinary protein ≥ 1.5 g/d (OR = 1.98, 95%CI 1.46-2.68), lambda-chain value (WMD = 29.02, 95%CI 16.55-41.49), abnormal free light-chain ratio (OR = 4.16, 95%CI 1.65-10.47), bone marrow puncture rate (OR = 5.11, 95% CI 1.31-19.95), and abnormal bone marrow outcome rate (OR = 9.63, 95%CI 1.98-46.88). Multivariate analysis showed urinary protein ≥ 1.5 g/d (OR = 2.80, 95%CI 1.53-5.15) and an abnormal free light-chain ratio (OR = 6.98, 95%CI 4.10-11.91) were associated with predictors of MGRS.
CONCLUSIONS: Compared with non-MGRS patients with monoclonal gammopathy and concomitant kidney diseases, patients with MGRS were older, had fewer underlying diseases, more urinary protein, more abnormal free light-chain ratio, and more abnormal bone marrow results. Urinary protein ≥ 1.5 g/d and an abnormal free light-chain ratio were independent risk factors for MGRS.