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基于真实世界数据的住院患者环孢素相关急性肾损伤发生情况及相关因素分析
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| 篇名： | 基于真实世界数据的住院患者环孢素相关急性肾损伤发生情况及相关因素分析 |
| TITLE： | Analysis of the incidence and associated factors of cyclosporine-associated acute kidney injury in hospitalized patients based on real-world data |
| 摘要： | 目的 分析住院患者环孢素（CsA）相关急性肾损伤（AKI）的发生情况，挖掘其影响因素并构建风险预测模型。方法采用单中心回顾性研究方法，纳入2018年1月－2024年7月于山东第一医科大学第一附属医院（山东省千佛山医院）接受CsA治疗的住院患者的临床资料，根据其AKI发生情况将其分为AKI组和非AKI组，采用单因素分析及多因素Logistic回归分析筛选CsA相关AKI的独立因素，构建风险预测模型并评估其性能。结果共纳入439例患者，其中54例发生CsA相关AKI，发生率为12.30%。合并肺部细菌感染、巨细胞病毒血症、呼吸衰竭、肾功能不全、消化道出血和接受经外周中心静脉置管术与CsA相关AKI的发生呈正相关（比值比分别为763.750、16.944、41.933、236.806、17.537、212.789，P＜0.05），尿酸、前白蛋白、钙水平则与之呈负相关（比值比分别为0.983、0.967、0.058，P＜0.05）。根据上述因素所建预测模型经Hosmer-Lemeshow检验拟合的χ2为10.254（P＞0.05），十折交叉验证的平均曲线下面积（AUC）为0.885；受试者操作特征曲线的AUC为0.883，最佳截断值（0.1）下的敏感度、特异性分别为84.3%、80.4%。结论合并肺部细菌感染、巨细胞病毒血症等6个因素为CsA相关AKI发生的正相关因素，尿酸、前白蛋白、钙水平则为负相关因素；基于上述因素构建的风险预测模型具有良好的预测性能，可辅助临床开展早期风险评估与个体化干预。 |
| ABSTRACT： | OBJECTIVE To analyze the incidence of cyclosporine （CsA）-associated acute kidney injury （AKI） in hospitalized patients， identify influencing factors， and construct a risk prediction model. METHODS A single-center retrospective study was conducted， enrolling clinical data from hospitalized patients treated with CsA at the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital from January 2018 to July 2024. The patients were classified into AKI group and non-AKI group based on the occurrence of CsA-related AKI. Univariate analysis and multivariate Logistic regression analysis were used to identify independent risk factors for CsA-related AKI， and a risk prediction model was constructed and its performance was evaluated. RESULTS A total of 439 patients were included， of whom 54 developed CsA-related AKI， with an incidence rate of 12.30%. The occurrence of CsA-associated AKI was positively correlated with concurrent bacterial pulmonary infection， cytomegalovirus viremia， respiratory failure， renal insufficiency， gastrointestinal bleeding， and peripheral central venous catheterization （odds ratios of 763.750， 16.944， 41.933， 236.806， 17.537 and 212.789， respectively； P ＜0.05）； while uric acid， prealbumin， and calcium levels were negatively associated with it （odds ratios of 0.983， 0.967 and 0.058， respectively； P ＜0.05）. The prediction model constructed based on the above factors yielded a χ 2 value of 10.254 （ P ＞0.05） in the Hosmer-Lemeshow test. The average area under the curve （AUC） from 10-fold cross-validation was 0.885. The AUC of the receiver operating characteristic curve was 0.883， with a sensitivity of 84.3% and a specificity of 80.4%， respectively， at the optimal cutoff value of 0.1. CONCLUSIONS Six factors， including concurrent bacterial pulmonary infection and cytomegalovirus viremia， are positively associated with the occurrence of CsA-related AKI； while uric acid， prealbumin， and calcium levels are negatively associated. The Logistic regression model constructed based on these factors demonstrates good predictive performance and can assist clinic in conducting early risk assessment and personalized interventions. |
| 期刊： | 2026年第37卷第12期 |
| 作者： | 窦亚晴；劳家辉；王雪；孙彦莹；黄欣；李汉兵；李晓 |
| AUTHORS： | DOU Yaqing，LAO Jiahui，WANG Xue，SUN Yanying，HUANG Xin，LI Hanbing，LI Xiao |
| 关键字： | 环孢素; 急性肾损伤; 危险因素; 预测模型; 真实世界研究 |
| KEYWORDS： | cyclosporine; acute kidney injury; risk factors; predictive model; real-world study |
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