摘要
目的探究IgA肾病(IgAN)患者的血清总胆红素(TB)水平与肾脏不良预后的关系。方法回顾性分析2018年1月至2021年1月于天门市第一人民医院就诊并通过肾活检诊断为原发性IgAN的149例患者的临床及病理资料,根据IgAN患者的血清TB水平分为低TB组(L-TB组,76例)和高TB组(H-TB组,73例),比较两组的临床及病理资料。采用Kaplan-Meier生存曲线评估患者的肾脏累积生存率,采用Cox回归模型法分析影响IgAN患者病情进展的危险因素,采用平滑曲线拟合及阈值分析探究血清TB水平与IgAN肾脏不良预后的关系。结果L-TB组的低密度脂蛋白胆固醇显著高于H-TB组,血清TB显著低于H-TB组,差异均有统计学意义(均P<0.05)。Kaplan-Meier生存曲线分析结果显示,L-TB组患者的IgAN病情进展的风险明显高于H-TB组(χ^(2)=5.552,P=0.019)。多因素Cox回归分析结果显示TB降低(HR=0.74,95%CI:0.61~0.88,P=0.017)、血肌酐升高(HR=1.30,95%CI:1.21~1.98,P=0.021)、出现节段性肾小球硬化(S1)(HR=1.48,95%CI:1.22~6.52,P=0.020)为IgAN患者病情进展的危险因素。平滑曲线拟合及阈值效应分析结果显示,血清TB水平与IgAN肾脏不良预后相对危险度(RR)之间存在近似线性相关关系,即血清TB水平越高,IgAN患者出现不良预后的相对危险度越低(RR=0.80,95%CI:0.70~0.90,P=0.004)。结论血清TB水平降低与IgAN的病情进展呈负相关,是病情进展独立的危险因素。
Objective To investigate the relationship between serum total bilirubin levels and poor renal prognosis in patients with IgA nephropathy(IgAN).Methods To retrospectively analyze the clinical and pathological data of patients with primary IgAN who attended the First People's Hospital of Tianmen in Hubei Province from January 2018 to January 2021 and were diagnosed by renal biopsy.The patients with IgAN were divided into low total bilirubin(TB)group(L-TB group,76 cases)and high bilirubin group(H-TB group,73 cases)according to the median serum total bilirubin level,and the differences in clinical and pathological data between the two groups were compared.Kaplan-Meier survival curves were used to assess the cumulative renal survival of patients,Cox regression modeling was used to analyze the risk factors affecting the progression of IgAN patients,and smoothing curve fitting and threshold analysis were used to explore the relationship between serum total bilirubin levels and poor renal prognosis of IgAN.Results Comparison of the baseline data between the two groups showed that low-density lipoprotein was significantly higher in the L-TB group than in the H-TB group,and total serum bilirubin were significantly lower than in the H-TB group(all P<0.05).The results of Kaplan-Meier survival curve analysis showed that patients in the L-TB group had a significantly higher risk of progression of IgAN than in the H-TB group(χ^(2)=5.552,P=0.019).Multi-factor Cox regression analysis showed decreased TB(HR=0.74,95%CI:0.61-0.88,P=0.017),increased blood creatinine(HR=1.30,95%CI:1.21-1.98,P=0.021),and the development of segmental glomerulosclerosis(S1)(HR=1.48,95%CI:1.22-6.52,P=0.020)as risk factors for disease progression in patients with IgAN.Smoothing curve fitting and threshold effect analysis showed an approximately linear correlation between serum TB level and relative risk of poor renal prognosis(RR)in IgAN.That is,the higher serum TB level,the lower relative risk of poor prognosis in IgAN patients(RR=0.80,95%CI:0.70-0.90,P=
作者
刘淑芬
汪慧
邵宁
黄浩
Liu Shufen;Wang Hui;Shao Ning;Huang Hao(Medical College of Wuhan University of Science and Technology,Wuhan 430065,China;Department of Nephrology,the First People′s Hospital of Tianmen in Hubei Province,Tianmen 431700,China)
出处
《国际泌尿系统杂志》
2024年第1期125-130,共6页
International Journal of Urology and Nephrology
基金
湖北省卫生健康委联合基金项目(WJ2019H214)。
