| 卫 洁,王志娟,包 婷,李新玉,王德光.尿系列蛋白与原发性IgA肾病患者预后和牛津分型的关系研究[J].,2024,(13):2483-2487 |
| 尿系列蛋白与原发性IgA肾病患者预后和牛津分型的关系研究 |
| Study on the Relationship between Urinary Series Proteins and Prognosis and Oxford Classification in Patients with Primary IgA Nephropathy |
| 投稿时间：2024-01-27 修订日期：2024-02-23 |
| DOI：10.13241/j.cnki.pmb.2024.13.015 |
| 中文关键词: IgA肾病 尿免疫球蛋白 尿N-乙酰-β-D葡萄糖苷酶 尿β2微球蛋白 牛津分型 预后 |
| 英文关键词: IgA nephropathy Urinary immunoglobulin Urinary N-acetyl-β-D-glucosidase Urinary β2 microglobulin Oxford classification Prognosis |
| 基金项目:安徽省自然科学基金面上项目（2008085MH244） |
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| 中文摘要: |
| 摘要 目的：分析原发性免疫球蛋白肾病（IgAN）患者的尿系列蛋白资料，探讨尿系列蛋白与该人群预后及其对牛津分型的关系。方法：回顾性分析2012年1月至2021年7月期间安徽医科大学第二附属医院收治的原发性IgAN患者146例的临床资料。对所有患者进行随访，采用终点事件评估肾脏预后。采用受试者工作特征（ROC）曲线获得尿系列蛋白的截断值，并根据截断值将尿系列蛋白分为高水平组和低水平组，采用Kaplan-Meier生存曲线分析两组不同水平尿系列蛋白IgAN患者的预后。采用COX风险比例模型分析IgAN患者肾脏预后的影响因素。对比不同牛津分型患者尿系列蛋白的差异。结果：随访时间中位数为78.00（58.00,95.00）个月，共有42例患者发生终点事件。Kaplan-Meier生存曲线显示尿N-乙酰-β-D葡萄糖苷酶（NAG）、尿α1微球蛋白（α1-MG）、尿β2微球蛋白（β2-MG）、尿微量白蛋白（Alb）、尿免疫球蛋白（IgG）和尿转铁蛋白（TRF）低水平组累计生存率显著高于尿NAG、尿α1-MG、尿β2-MG、尿Alb、尿IgG和尿TRF高水平组（P<0.05）；单因素COX生存分析结果显示，预后良好组尿NAG、尿β2-MG和尿IgG水平显著低于预后不良组（P<0.05）；多因素COX生存分析结果显示尿NAG、尿IgG升高和尿β2-MG升高为原发性IgAN患者肾脏预后不良的独立危险因素。内皮细胞增生病变尿NAG水平明显高于其他两组，节段性硬化病变尿IgG明显高于其他两组，肾小管萎缩/间质纤维化尿β2-MG明显高于其他两组（P<0.05）。结论：尿NAG升高、尿IgG升高和尿β2-MG升高为原发性IgAN患者肾脏预后不良的独立危险因素，且与牛津分型中内皮细胞增生、节段性硬化、肾小管萎缩或肾间质纤维化的发生有关。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the data of urinary serial proteins in patients with primary immunoglobulin nephropathy (IgAN), and to explore the relationship between urinary serial proteins and the prognosis of this population and its relationship with Oxford classification. Methods: The clinical data of 146 primary IgAN patients admitted to the Second Affiliated Hospital of Anhui Medical University from January 2012 to July 2021 were retrospectively analyzed. All patients were followed up, and the renal prognosis was evaluated by endpoint events. The cut-off value of urinary series proteins was obtained by receiver operating characteristic (ROC) curve, and the urinary series proteins were divided into high-level group and low-level group according to the cut-off value, the prognosis of IgAN patients with different levels of urinary series proteins were analyzed by Kaplan-Meier survival curve. The influencing factors of renal prognosis in IgAN patients were analyzed by COX proportional hazard model. The differences of urinary series proteins in patients with different Oxford classification were compared. Results: The median follow-up time was 78.00(58.00,95.00) months, and a total of 42 patients had endpoint events. Kaplan-Meier survival curve showed that urinary N-acetyl-β-D-glucosidase (NAG), urinary α1-microglobulin (α1-MG), urinary β2-microglobulin (β2-MG), urinary microalbumin (Alb), urinary immunoglobulin (IgG) and urinary transferrin (TRF) low level group had significantly higher cumulative survival rate than urinary NAG, urinary α1-MG, urinary β2-MG, urinary Alb, urinary IgG and urinary TRF high level group(P<0.05). Univariate COX survival analysis showed that, the levels of urinary NAG, urinary ?2-MG and urinary IgG in good prognosis group were significantly lower than those in poor prognosis group (P<0.05). Multivariate COX survival analysis showed that elevated urinary NAG, urinary IgG and urinary β2-MG were independent risk factors for poor renal prognosis in primary IgAN patients. The urinary NAG level of endothelial cell proliferative lesions was significantly higher than that in other two groups, the urinary IgG of segmental sclerosis lesions was significantly higher than that in other two groups, and the urinary β2-MG of renal tubular atrophy/interstitial fibrosis was significantly higher than that in other two groups (P<0.05). Conclusion: The increase of urinary NAG, urinary IgG and urinary β2-MG are independent risk factors for poor renal prognosis in primary IgAN patients, and are associate with endothelial cell proliferation, segmental sclerosis, tubular atrophy or renal interstitial fibrosis in Oxford classification. |
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