移植肾病理指标对不同时期移植肾功能异常的预测价值
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作者单位:

1南京医科大学第二附属医院泌尿外科,江苏 南京 210011 ; 2.南京医科大学第一附属医院泌尿外科,江苏 南京 210029

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R699.2

基金项目:

国家自然科学基金(82470790,82170769);江苏省科技计划专项资金(重点研发计划社会发展)项目(BE2023784)


Predictive value of renal allograft pathology for abnormal renal allograft function at different post⁃transplant periods
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1Department of Urology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011 ; 2.Departmentof Urology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029 ,China

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    摘要:

    目的:探究移植肾活组织检查的病理指标与不同时期移植肾功能异常的相关性,评价移植肾病理指标在移植肾功能异常中的诊断价值,建立预测移植肾预后的模型。方法:回顾性分析2015—2018年于南京医科大学第一附属医院接受移植肾活检的同种异体肾移植手术受者的临床资料及病理指标。将总体样本基于不同活检后时间(活检时、活检后第1年、活检后第3年、活检后第5年)分别进行统计学分析。采用单因素分析筛选对肾功能异常有影响的指标,通过二元Logistic回归建立模型并绘制列线图;此外,通过混合效应Logistic回归探究在各阶段均与肾功能异常相关因素的动态效应。通过受试者工作特征 (receiver operating characteristic,ROC)曲线、对应的曲线下面积(area under the curve,AUC)、校准曲线判断模型的判别效度以及与实际情况的一致性。结果:共纳入121例患者,按照移植肾活检后时间将总体样本分为活检时、活检后1年、3年、5年: i评分≥1分与活检时、活检后第1、3、5年肾功能异常显著相关;动态效应分析结果为i评分≥1分与移植肾穿刺后5年内的肾功能恶化有关。依据上述统计结果绘制出列线图,AUC显示模型具有较好的判别效度。校准曲线显示模型的移植肾功能异常发生的预测概率与实际概率一致性较高。结论:构建了一个预测不同时间点移植肾功能异常的列线图模型,有效提升了移植肾穿刺后患者管理的精准度。

    Abstract:

    Objective:To explore the correlation between pathological indicators of renal allograft biopsy and abnormal renal allograft function at different stages,to evaluate the diagnostic value of pathological indicators in abnormal renal allograft function,and to establish a model for predicting the prognosis of renal allografts. Methods:This study retrospectively analyzed the clinical data and pathological indicators of kidney transplant recipients who underwent renal allograft biopsy at the First Affiliated Hospital of Nanjing Medical University between 2015 and 2018. The total sample was statistically analyzed based on different post-biopsy times(at biopsy, 1 year after biopsy,3 years after biopsy,and 5 years after biopsy). Univariate analysis was conducted to screen for indicators that affect abnormal renal allograft function. The model was established using binary logistic regression to draw a nomogram. Mixed - effects logistic regression was further applied to investigate the dynamic effects of factors consistently associated with abnormal renal allograft function across all stages. According to receiver operating characteristic curve(ROC),corresponding Area under the curve(AUC)and calibration curve,the discriminant validity and consistency of the model with the actual situation were judged. Results:A total of 121 patients were included in this study. According to the time after biopsy of the transplanted kidney,the total samples were divided into four groups:at the time of biopsy,1 year after biopsy,3 years after biopsy,and 5 years after biopsy. The i score ≥1 was significantly correlated with renal function at the time of biopsy and at 1,3,and 5 years after biopsy. The dynamic effects analysis indicated that i-score ≥ 1 was associated with renal function deterioration within five years after kidney transplantation. A nomogram was constructed based on the above statistical results. The AUC indicated that the model had good discriminative validity. The calibration curve showed that the predicted probability of abnormal renal allograft function was in good agreement with the actual probability. Conclusion:This study constructed a nomogram model capable of predicting abnormal renal allograft function at different time points which demonstrated a good predictive ability and could effectively improve the precision of post - biopsy patient management for renal transplant recipients.

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陈语悉,高翔,许洁,陈浩,孙黎,费爽,谭若芸,王子杰,顾民.移植肾病理指标对不同时期移植肾功能异常的预测价值[J].南京医科大学学报(自然科学版),2026,46(4):577-586

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  • 收稿日期:2025-09-09
  • 最后修改日期:2025-12-23
  • 录用日期:2026-01-06
  • 在线发布日期: 2026-04-14
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