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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2023, Vol. 12 ›› Issue (01) : 13 -19. doi: 10.3877/cma.j.issn.2095-3216.2023.01.003

论著

血脂与IgA肾病患者肾脏预后的相关性研究
邓荣珍1, 罗宇珍1, 赵若蓓2, 邓杨2, 廖蕴华2, 潘玲2,†()   
  1. 1. 537200　广西桂平市人民医院肾内科
    2. 530021　南宁，广西医科大学第一附属医院肾内科
  • 收稿日期:2022-03-29 出版日期:2023-02-28
  • 通信作者: 潘玲
  • 基金资助:
    国家自然科学基金(81960135); 广西自然科学基金(2018GXNSFBA050040)

Study on the correlation between blood lipids and renal prognosis in patients with IgA nephropathy

Rongzhen Deng1, Yuzhen Luo1, Ruobei Zhao2, Yang Deng2, Yunhua Liao2, Ling Pan2,†()   

  1. 1. Department of Nephrology, Guiping People′s Hospital, Guiping 537200
    2. Department of Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning 530021; Guangxi Zhuang Autonomous Region, China
  • Received:2022-03-29 Published:2023-02-28
  • Corresponding author: Ling Pan
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引用本文：

邓荣珍, 罗宇珍, 赵若蓓, 邓杨, 廖蕴华, 潘玲. 血脂与IgA肾病患者肾脏预后的相关性研究[J]. 中华肾病研究电子杂志, 2023, 12(01): 13-19.

Rongzhen Deng, Yuzhen Luo, Ruobei Zhao, Yang Deng, Yunhua Liao, Ling Pan. Study on the correlation between blood lipids and renal prognosis in patients with IgA nephropathy[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(01): 13-19.

目的

了解原发性IgA肾病(IgAN)血脂异常患者的临床、病理特征，探讨血脂对IgAN肾脏预后的影响。

方法

回顾性分析2000年1月1日至2018年12月31日在我院肾活检确诊的原发性IgAN患者的资料，随访截止2020年1月1日，随访的终点事件是终末期肾病(ESRD)或估算的肾小球滤过率(eGFR)下降≥50%，未达终点事件者随访最少1年。按肾活检时的基线血脂水平并根据血脂异常诊断标准，将IgAN患者分为血脂异常组(450例)及血脂正常组(331例)，血脂异常组包括高胆固醇组(高TC组)、高甘油三酯组(高TG组)、高低密度脂蛋白组(高LDL组)及低高密度脂蛋白组(低HDL组)4个单一指标亚组。参照IgAN牛津分型进行病理评分，Logistic回归和Cox回归模型分析影响IgAN患者预后的风险因素，采用Kaplan-Meier生存曲线比较血脂异常组和血脂正常组IgAN患者生存率的差异。

结果

血脂异常组年龄、身体质量指数(BMI)、血压、血肌酐、血尿酸、尿蛋白定量高于血脂正常组，而血白蛋白、eGFR低于血脂正常组(P<0.05)。根据牛津分型评分，与其它组比较，低HDL组IgAN患者的肾小管间质病变程度更重(P<0.05)。Logistic回归分析提示，年龄大(OR 1.044，95%CI：1.023～1.066，P<0.001)、高平均动脉压(OR 1.025，95%CI：1.008～1.043，P＝0.004)、低血红蛋白(OR 0.963，95%CI：0.950～0.976，P<0.001)、高TG(OR 1.008，95%CI：1.005～1.010，P<0.001)、低HDL(OR 0.546，95%CI：0.311～0.959，P＝0.035)、高24 h尿蛋白定量(OR 1.185，95%CI：1.039～1.352，P＝0.011)和高牛津分型T评分(OR 9.115，95%CI：5.297～15.685，P<0.001)是IgAN基线肾功能下降的风险因素。多因素Cox回归模型分析结果显示，低血红蛋白(OR 0.965，95%CI：0.949～0.980，P<0.001)、低基线eGFR(OR 0.984，95%CI：0.973～0.996，P＝0.008)、高24 h尿蛋白定量(OR 1.151，95%CI：1.043～1.271，P＝0.005)、高牛津分型T评分(OR 1.680，95%CI：1.033～2.732，P＝0.036)和高TG(OR 1.177，95%CI：1.038～1.334，P＝0.011)是IgAN肾脏不良预后的风险因素。Kaplan-Meier生存曲线分析显示，随访血脂异常组IgAN患者的肾脏中位生存时间显著短于血脂正常组(χ2＝8.316，P＝0.004)。

结论

HDL与肾小管间质病变相关，高TG是IgAN肾脏预后不良的风险因素，临床上应加强对IgAN患者的血脂监测。

关键词: IgA肾病, 血脂异常, 临床病理, 预后
Objective

To investigate the clinical and pathological characteristics of primary IgA nephropathy (IgAN) patients with dyslipidemia in order to explore the effect of blood lipids on the prognosis of IgAN kidney.

Methods

The data of patients with primary IgAN diagnosed by renal biopsy in our hospital from January 1, 2000 to December 31, 2018 were retrospectively analyzed. The follow-up was conducted until January 1, 2020. The end point of follow-up was end-stage renal disease (ESRD) or that the estimated glomerular filtration rate (eGFR) decreased by ≥ 50%. Those who did not reach the end point were followed up for at least 1 year. According to the baseline blood lipid level at the time of renal biopsy, IgAN patients were divided into normal blood lipid group (331 cases) and abnormal blood lipid group (450 cases) by the diagnostic criteria of abnormal blood lipid. The abnormal blood lipid group was further divided into four single-indicator subgroups: high cholesterol group, high triglyceride group, high LDL group and low HDL group. Pathological score was assessed according to the Oxford classification, and the risk factors affecting the prognosis of IgAN patients were analyzed by logistic regression analysis and Cox regression model methods. Kaplan-Meier survival curve was used to compare the difference in survival rate of IgAN patients between the abnormal blood lipid group and the normal blood lipid group.

Results

The age, body mass index (BMI), blood pressure, serum creatinine, serum uric acid and urine protein in the abnormal blood lipid group were higher than those in the normal blood lipid group, while the serum albumin and eGFR were lower than those in the normal blood lipid group (all P<0.05). According to the Oxford classification score, compared with other groups, the low HDL group showed that the degree of renal tubulointerstitial lesions of IgAN was more severe (P<0.05). Logistic regression analysis showed that old age (OR 1.044, 95%CI: 1.023-1.066, P<0.001), high mean arterial pressure (OR 1.025, 95%CI: 1.008-1.043, P=0.004), low hemoglobin (OR 0.963, 95%CI: 0.950-0.976, P<0.001), high triglyceride (OR 1.008, 95%CI: 1.005-1.010, P<0.001), low HDL (OR 0.546, 95%CI: 0.311-0.959, P=0.035), high 24-hour urine protein (OR 1.185, 95%CI: 1.039-1.352, P=0.011), and high Oxford classification T-score (OR 9.115, 95%CI: 5.297-15.685, P<0.001) were the influencing factors for the decline of IgAN baseline renal function. Multivariate Cox regression analysis showed that low hemoglobin (OR 0.965, 95%CI: 0.949-0.980, P<0.001), low baseline eGFR (OR 0.984, 95%CI: 0.973-0.996, P=0.008), high 24-hour urine protein (OR 1.151, 95%CI: 1.043-1.271, P=0.005), high Oxford classification T-score (OR 1.680, 95%CI: 1.033-2.732, P=0.036), and high triglyceride (OR 1.177, 95%CI: 1.038-1.334, P=0.011) were risk factors for the poor prognosis of IgAN kidney. Kaplan-Meier survival curve analysis showed that the median renal survival time of IgAN patients of the abnormal blood lipid group in the follow-up was significantly shorter than that in the normal blood lipid group (χ2=8.316, P=0.004).

Conclusion

HDL was associated with the renal tubulointerstitial lesions, and triglyceride was a risk factor for the poor renal prognosis of IgAN patients. In clinical practice, blood lipid monitoring in IgAN patients should be strengthened.

Key words: IgA nephropathy, Dyslipidemia, Clinicopathology, Prognosis
表1 血脂异常组与血脂正常组IgAN患者的一般临床资料和病理资料比较
指标 血脂异常组(n＝450) 血脂正常组(n＝331) t/χ2/Z值 P值
年龄(岁) 37.01±12.84 35.13±11.57 2.177 0.033
身体质量指数(kg/m2) 24.11±3.70 22.47±3.59 6.274 <0.001
男性[例(%)] 269(65.50) 142(34.50) 21.79 <0.001
收缩压(mmHg) 132.19±21.80 128.60±19.89 2.393 0.017
舒张压(mmHg) 84.47±1 4.16 80.67±12.70 3.780 <0.001
平均动脉压(mmHg) 100.39±15.78 96.65±14.10 －3.421 0.001
血红蛋白(g/L) 125.11±22.03 121.78±18.68 2.337 0.023
白蛋白(g/L) 31.70±9.32 36.78±5.78 －9.40 <0.001
血肌酐(μmol/L) 101(76，147) 91(69，136) －2.97 0.003
尿酸(μmol/L) 427(358，513) 386(307，479) －4.78 <0.001
估算的肾小球滤过率[ml/(min·1.73 m2)] 72.3(43.6，101.0) 81.5(48.6，107) －2.10 0.035
碳酸氢根(mmol/L) 24.4(22.8，26.0) 24.4(23.2，26.2) －1.17 0.242
同型半胱氨酸(μmol/L) 13(9.9，17.1) 13.2(10，17.5) －0.79 0.432
24 h尿蛋白定量(g) 1.81(0.82，3.43) 0.93(0.48，2.05) －6.80 <0.001
表2 IgAN患者基线肾功能下降影响因素的Logistic分析结果
变量 单因素分析 多因素分析
统计值 P值 OR(95%CI) P值
性别(男/女) 7.070 0.008    
年龄(岁) －5.580 <0.001 1.044(1.023～1.066) <0.001
身体质量指数(kg/m2) －1.617 0.106    
收缩压(mmHg) －9.499 <0.001    
舒张压(mmHg) －8.895 <0.001    
平均动脉压(mmHg) －9.622 <0.001 1.025(1.008～1.043) 0.004
白蛋白(g/L) 2.570 0.010    
血红蛋白(g/L) 9.036 <0.001 0.963(0.950～0.976) <0.001
胆固醇(mmol/L) －0.535 0.592    
甘油三酯(mmol/L) －4.587 <0.001 1.008(1.005～1.010) <0.001
高密度脂蛋白(mmol/L) －4.087 <0.001 0.546(0.311～0.959) 0.035
低密度脂蛋白(mmol/L) －0.263 0.793    
尿酸(μmol/L) －11.202 <0.001    
24 h尿蛋白定量(g) －9.395 <0.001 1.185(1.039～1.352) 0.011
肾脏病理牛津分型评分        
M 12.724 <0.001    
E 1.791 0.181    
S 36.270 <0.001    
T 245.515 <0.001 9.115(5.297～15.685) <0.001
C 13.227 <0.001    
表3 IgAN患者肾脏不良预后影响因素的Cox回归模型分析结果
变量 单因素分析 多因素分析
统计值 P值 OR(95%CI) P值
性别(男/女) 0.719(0.437～1.182) 0.193    
年龄(岁) 1.021(0.999～1.043) 0.058    
身体质量指数(kg/m2) 1.054(0.983～1.130) 0.141    
收缩压(mmHg) 1.031(1.021～1.042) <0.001    
舒张压(mmHg) <0.001      
平均动脉压(mmHg) 1.041(1.027～1.056) <0.001    
白蛋白(g/L) 0.963(0.934～0.993) 0.015    
血红蛋白(g/L) 0.954(0.941～0.968) <0.001 0.965(0.949～0.980) <0.001
胆固醇(mmol/L) 1.018(0.902～1.149) 0.767    
甘油三酯(mmol/L) 1.098(1.001～1.204) 0.047 1.177(1.038～1.334) 0.011
高密度脂蛋白(mmol/L) 1.125(0.670～1.889) 0.656    
低密度脂蛋白(mmol/L) 0.943(0.798～1.116) 0.496    
基线估算肾小球滤过率[ml/(min·1.73 m2)] 0.962(0.953～0.972) <0.001 0.984(0.973～0.996) 0.008
尿酸(μmol/L) 1.005(1.003～1.007) <0.001    
24 h尿蛋白定量(g) 1.237(1.142～1.339) <0.001 1.151(1.043～1.271) 0.005
肾脏病理牛津分型评分        
M 1.591(0.876～2.890) 0.127    
S 1.336(0.793～2.253) 0.277    
T 3.289(2.355～4.594) <0.001 1.680(1.033～2.732) 0.036
C 1.609(0.836～3.097) 0.155    
他汀治疗 1.500(0.880～2.556) 0.136    
激素治疗 0.971(0.573～1.645) 0.913    
免疫抑制剂治疗 1.996(1.147～3.475) 0.015    
图1 随访IgA肾病患者血脂正常组与血脂异常组的肾脏生存曲线比较(Kaplan-Meier分析)
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