Analysis Of Predictors Of Early Remission Induced By Cyclosporine A Combined With Glucocorticoid In Membranous Nephropathy

Background:Membranous nephropathy(MN)is one of the causes of end-stage renal disease(ESRD),and can be divided into idiopathic membranous nephropathy(IMN)and secondary according to whether the cause is clear There are two types of membranous nephropathy(SMN),idiopathic membranous nephropathy accounts for a relatively large proportion,and the prognosis is diverse.Studies at home and abroad now suggest that the incidence of MN is increasing year by year and the number of patients is younger,and IMN is increasing proportionally.Immunosuppressive therapy combined with glucocorticoid therapy can significantly improve disease remission rate and reduce the incidence of ESRD.Program.Calcineurin inhibitor +glucocorticoid is the only recommended initial treatment alternative.Cyclosporin A(Cyclosporin A,CsA)is one of the representative drugs.Due to the effect and reasonable price,cyclosporin A combined with glucocorticoid has been widely used in clinical practice and is an independent choice for many patients.Many studies have confirmed that this treatment can significantly improve the clinical remission rate of IMN,but some patients still have not achieved clinical remission.Even if relief is achieved,the time required varies.Immunomodulation therapy is a protracted battle.Long-term drug therapy increases the financial burden of the family and increases the possibility of adverse drug reactions,and early remission affects long-term prognosis.Therefore,it is of great significance to pre-judge the sensitivity of patients to immunomodulatory treatment.At present,there are few studies on the predictive factors of early remission induced by cyclosporin A combined with glucocorticoids,so this study is a supplement to provide some theoretical references for clinicians to evaluate the effect of drug treatment,improve the early remission rate of disease,and improve long-term prognosis.Objective:A retrospective analysis of the remission of our patients with idiopathic membranous nephropathy using cyclosporin A combined with glucocorticoid treatment for 3 months,comparing the general conditions,common laboratory tests and pathological results of the remission and non-remission groups before treatment Differences,and in the remission group,detailed analysis of the baseline clinical indicators of the three groups of patients who achieved remission at the first month,second month,and third month according to the time of the first remission,looking for the prediction of cyclosporin A combined with glucocorticoid induction The predictive factors of early remission of patients provide a theoretical reference for clinicians to evaluate the effect of drug treatment.Materials and Methods:Retrospective analysis of the diagnosis of idiopathic membranous nephropathy confirmed by renal biopsy in the Department of Nephrology,Department of Nephrology,First Hospital of Jilin University from December 2013 to September2019,and the initial treatment plan was cyclosporin A combined with glucocorticoid Hormones,and patients who were regularly followed up in the outpatient clinic for at least 3 months,collected baseline clinical data and outpatient follow-up data within 2weeks before their immunomodulatory treatment.Analyze the follow-up data of outpatient clinics,and divide them into remission group and non-remission group according to whether they achieved clinical remission(including partial remission +complete remission)at 3 months of immunomodulatory treatment.The remission component was divided into the remission group at 1 month,2 months and 3 months after treatment.The baseline clinical data of the three groups were statistically analyzed to find predictive factors related to the speed of early remission.Result:1.A total of 190 IMN patients were included in this retrospective analysis,including 141 male patients and 49 female patients,with an average age of 46.94 ±14.20 years old,and 37 patients with renal pathological membranous nephropathy in stages I,II,and III(19.5%),145 cases(76.3%),8 cases(4.2%),without stage IV membranous nephropathy.A total of 115 patients achieved clinical remission during the 3-month follow-up,with a total remission rate of 60.5%,mainly partial clinical remission(95.7%),and the remaining 75 patients did not achieve clinical remission.2.At 3 months of treatment,the absolute value of lymphocytes,red blood cell count,hemoglobin concentration,hematocrit,and hemoglobin in baseline data of the remission group(115 patients)before immunotherapy were compared with those in the non-remission group(75 patients),Prealbumin and white ball are relatively high,and the ratio of platelet count to lymphocyte absolute value,fibrinogen,hematuria under microscope,α2 globulin is low,P <0.05,the difference has Statistical significance.3.Logistic regression analysis found that hemoglobin concentration,hemoglobin,and absolute values of lymphocytes were independently positively correlated with clinical remission(P <0.05).Draw the receiver operator characteristic curve(ROC)of independent influencing factors,where the area under curve(AUC)of ALB is 0.664(P<0.001),and the cutoff value is 20.3g/L.The prediction sensitivity is 80.9%,and the specificity is 49.3%;the area under the ROC curve of HGB is 0.636(P<0.05),with 135.5g/L as the cutoff value,the prediction sensitivity is 76.5%,and the specificity is 49.3%;The product of ROC curve of LYM is 0.608(P<0.05),with2.125*10^9/L as the cutoff value,its predicted sensitivity is 47.8%,and its specificity is 74.6%.According to the cutoff value,the three independent influencing factors are divided into two groups that are higher than the cutoff value and lower than the cutoff value.The three independent influencing factors are all protective factors.When the value is greater than the high cutoff value,the patient has a better effect on immunomodulatory treatment.The greater the likelihood of obtaining clinical remission.4.According to the time for the first clinical remission within 3 months,the patients in the remission group were divided into the first month(44 cases),the second month(41 cases),and the third month(30 cases)remission group.After statistical analysis of each clinical baseline index,six potential influencing factors including hemoglobin concentration,hematocrit,prealbumin,serum albumin,fibrinogen,and α2 globulin were obtained.Comparison of potential influencing factors between the two groups: Compared with the first month and the second month remission group,high serum albumin and low fibrinogen are more conducive to remission in the first month,there is a statistical difference(P <0.05);The comparison between the 2 month and the 3rd month remission group showed that high hemoglobin concentration and high prealbumin factors were beneficial to the 2ndmonth remission,there was a statistical difference(P <0.05);serum albumin in the 1st month remission group The concentration of prealbumin and hemoglobin was higher than that in the third month remission group,and the hematocrit and fibrinogen were lower than that in the third month remission group(P <0.05).Conclusion:1.IMN patients treated with cyclosporin A combined with glucocorticoids obtain early clinical remission and the nutritional status of patients(red blood cell count,hemoglobin concentration,Hematocrit,hemoglobin,prealbumin,white ball ratio)within 3 months,Body immunity(PLR,absolute value of lymphocytes,α2-globulin),fibrinogen and hematuria under microscope.2.The higher the hemoglobin concentration,blood albumin,prealbumin concentration,and absolute lymphocyte value,the lower the PLR and fibrinogen,and the lighter the hematuria under the microscope.The greater the possibility.Blood albumin is the best independent predictor of early remission within 3 months of IMN.3.Among them,higher blood albumin and hemoglobin and lower fibrinogen are not only predictive factors of whether IMN can obtain early remission,but also an advantageous factor to accelerate remission.4.Use simple and easily available predictive indicators to evaluate the drug efficacy and remission rate of patients before immunomodulatory therapy.If necessary,change the treatment plan,and at the same time increase the patient’s confidence in defeating the disease,ease the physical and mental burden and improve compliance.