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

doi:10.3877/cma.j.issn.2095-3216.2023.01.003

Abstract

Abstract:

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

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.

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References 29

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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

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

变量	单因素分析		多因素分析
变量	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

变量	单因素分析		多因素分析
变量	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

变量	单因素分析		多因素分析
变量	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

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