■与M型磷脂酶A2受体(PLA2R)相关的原发性膜性肾病(PMN)是成年人的免疫相关疾病,发病率和治疗反应不断增加,其中炎症可能导致多因素免疫发病。纤维蛋白原-白蛋白比值(FAR),作为一种新型的炎症生物标志物,PMN还不清楚。因此,本研究旨在阐明FAR与PMN的疾病活动性和治疗反应之间的关系.
■2017年1月至2021年12月在南京医科大学第一附属医院招募经活检证实的磷脂酶A2受体(PLA2R)相关PMN肾病综合征患者110例。采用Cox回归和受试者工作特征(ROC)曲线分析探讨非缓解(NR)的独立危险因素和FAR的预测能力。根据最优截止值,研究患者分为低FAR组(≤临界值)和高FAR组(>临界值).使用Spearman相关性检查FAR与基线临床病理特征之间的关联。采用Kaplan-Meier法评估FAR对缓解的影响。
■在整个研究队列中,78例(70.9%)患者达到完全缓解或部分缓解(CR或PR)。FAR预测缓解结局(CR+PR)的最佳临界值为0.233。Kaplan-Meier生存分析表明,与低FAR组(≤0.233)相比,高FAR组(>0.233)达到CR或PR的可能性显着降低(LogRank检验,p=0.021)。较高水平的FAR被确定为NR的独立危险因素,高FAR组的NR可能性是低FAR组的2.27倍(HR2.27,95%CI1.01,5.13,p=0.048).这些关系在钙调磷酸酶抑制剂(CNI)接受者之间的进一步分析中保持稳健。在多元Cox回归模型中,高FAR组的NR发生率是低FAR组的4.00倍(HR4.00,95%CI1.41,11.31,p=0.009).此外,ROC分析显示FAR对CR或PR的预测价值,曲线下面积(AUC)为0.738,抗PLA2RAb的AUC为0.675。当组合FAR和抗PLA2RAb时,AUC升至0.766.
■FAR与PMN中的蛋白尿和抗PLA2RAb显著相关。作为NR的独立风险因素,FAR可能作为一种潜在的基于炎症的预后工具,用于识别治疗反应不佳的病例。结局的最佳预测临界值为0.233.
UNASSIGNED: The M-type phospholipase A2 receptor (PLA2R)-associated primary membranous nephropathy (PMN) is an immune-related disease in adults with increasing morbidity and variable treatment response, in which inflammation may contribute to the multifactorial immunopathogenesis. The relationship between fibrinogen-albumin ratio (FAR), serving as a novel inflammatory biomarker, and PMN is still unclear. Therefore, this study aims to clarify the association between FAR and disease activity and therapy response of PMN.
UNASSIGNED: 110 biopsy-proven phospholipase A2 receptor (PLA2R) -associated PMN participants with nephrotic syndrome from January 2017 to December 2021 were recruited in the First Affiliated Hospital of Nanjing Medical University. The independent risk factors of non-remission (NR) and the predictive ability of FAR were explored by Cox regression and receiver-operating characteristic (ROC) curve analysis. According to the optimal cutoff value, study patients were categorized into the low-FAR group (≤the cutoff value) and the high-FAR group (>the cutoff value). Spearman\'s correlations were used to examine the associations between FAR and baseline clinicopathological characteristics. Kaplan-Meier method was used to assess the effects of FAR on remission.
UNASSIGNED: In the entire study cohort, 78 (70.9%) patients reached complete or partial remission (CR or PR). The optimal cutoff value of FAR for predicting the remission outcome (CR + PR) was 0.233. The Kaplan-Meier survival analysis demonstrated that the high-FAR group (>0.233) had a significantly lower probability to achieve CR or PR compared to the low-FAR group (≤0.233) (Log Rank test, p = 0.021). Higher levels of FAR were identified as an independent risk factor for NR, and the high-FAR group was associated with a 2.27 times higher likelihood of NR than the low-FAR group (HR 2.27, 95% CI 1.01, 5.13, p = 0.048). These relationships remained robust with further analysis among calcineurin inhibitors (CNIs)-receivers. In the multivariate Cox regression model, the incidence of NR was 4.00 times higher in the high-FAR group than in the low-FAR group (HR 4.00, 95% CI 1.41, 11.31, p = 0.009). Moreover, ROC analysis revealed the predictive value of FAR for CR or PR with a 0.738 area under curve (AUC), and the AUC of anti-PLA2R Ab was 0.675. When combining FAR and anti-PLA2R Ab, the AUC was boosted to 0.766.
UNASSIGNED: FAR was significantly correlated with proteinuria and anti-PLA2R Ab in PMN. As an independent risk factor for NR, FAR might serve as a potential inflammation-based prognostic tool for identifying cases with poor treatment response, and the best predictive cutoff value for outcomes was 0.233.