探讨尿β2-微球蛋白(β2-MG)在原发性膜性肾病(PMN)患者预后评估中的作用。

回顾性分析2018年12月至2023年11月在安徽医科大学附属阜阳医院首诊收治的66例PMN患者，根据尿β2-MG水平分为高β2-MG组(尿β2-MG>0.3 mg/L，40例)和低β2-MG组(尿β2-MG≤0.3 mg/L，26例)。收集患者的一般资料、实验室指标和肾穿刺活检病理检查结果。采用Logistic回归方法分析尿β2-MG的相关影响因素，以受试者工作特征曲线分析尿β2-MG对患者预后的评估作用。

首诊时，高β2-MG组的平均动脉压、血清肌酐、24 h尿蛋白、抗磷脂酶A2受体抗体、肾间质病变积分均大于低β2-MG组，而eGFR则小于低β2-MG组(P均<0.05)。多因素分析显示，eGFR、24 h尿蛋白、抗磷脂酶A2受体抗体、肾间质病变积分是高尿β2-MG的独立危险因素。相比首诊数据，高β2-MG组末次随访的血清肌酐、24 h尿蛋白及抗磷脂酶A2受体抗体水平均明显升高，eGFR水平则明显降低(P均<0.05)，且各指标与低β2-MG组相比，亦有统计学差异(P均<0.05)。与低β2-MG组相比，高β2-MG组的预后不良率更高(P<0.05)。受试者工作特征曲线分析显示，尿β2-MG最佳截断值为0.303 mg/L时、曲线下面积为0.875，敏感性为93.7%、特异性为76.9%。

抗磷脂酶A2受体抗体、eGFR、24 h尿蛋白、肾间质病变积分是高尿β2-MG的独立危险因素，高尿β2-MG患者预后较差。尿β2-MG水平有可能预测PMN患者的病情转归，在免疫抑制疗法中具有参考价值。

To investigate the role of urinary β2-microglobulin (β2-MG) in evaluating the prognosis of patients with primary membranous nephropathy (PMN).

A retrospective analysis was conducted in 66 patients with PMN who were first admitted to the Fuyang Hospital Affiliated to Anhui Medical University from December 2018 to November 2023. According to their urinary β2-MG levels, they were divided into a high β2-MG group (40 cases) and a low β2-MG group (26 cases). The general information, laboratory indicators, and renal biopsy pathology results of the patients were collected. Logistic regression method was applied to analyze the related influencing factors of urinary β2-MG. And the prognostic role of urinary β2-MG in the patients was analyzed with the receiver operating characteristic (ROC) curve.

At the first admission, compared with the low β2-MG group, the high β2-MG group showed higher levels of mean arterial pressure, serum creatinine, 24-hour urinary protein, anti-phospholipase A2 receptor antibody, and renal interstitial lesion score, but showed lower level of eGFR (all P<0.05). Multivariate analysis showed that eGFR, 24-hour urinary protein, anti-phospholipase A2 receptor antibody, and renal interstitial lesion score were independent risk factors for the high level of urinary β2-MG. Compared with data at the first admission, the levels of serum creatinine, 24-hour urinary protein, and anti-phospholipase A2 receptor antibody in the high β2-MG group at the last follow-up were significantly higher, while eGFR was lower (all P<0.05). And the indicators were also statistically different between the two groups (all P<0.05). Compared with the low β2-MG group, the high β2-MG group had a higher incidence of poor prognosis (P<0.05). The ROC curve analysis showed that the optimal cutoff value for urinary β2-MG was 0.303 mg/L, and the area under the curve was 0.875, with the sensitivity being 93.7% and the specificity being 76.9%.

Anti-phospholipase A2 receptor antibody, eGFR, 24 h urinary protein, and renal interstitial lesion score were independent risk factors for high urinary β2-MG, and patients with high urinary β2-MG had poor prognosis. Urinary β2-MG level might be used for predicting the prognosis of PMN patients, which may be of value for reference during the immunosuppressive therapy.