Xu Xin, Wang Guobao, Chen Nan, Lu Tao, Nie Sheng, Xu Gang, Zhang Ping, Luo Yang, Wang Yongping, Wang Xiaobin, Schwartz Joel, Geng Jian, Hou Fan Fan
Renal Division, Nanfang Hospital, Southern Medical University, The National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China.
Renal Division, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China.
J Am Soc Nephrol. 2016 Dec;27(12):3739-3746. doi: 10.1681/ASN.2016010093. Epub 2016 Jun 30.
The effect of air pollution on the changing pattern of glomerulopathy has not been studied. We estimated the profile of and temporal change in glomerular diseases in an 11-year renal biopsy series including 71,151 native biopsies at 938 hospitals spanning 282 cities in China from 2004 to 2014, and examined the association of long-term exposure to fine particulate matter of <2.5 μm (PM) with glomerulopathy. After age and region standardization, we identified IgA nephropathy as the leading type of glomerulopathy, with a frequency of 28.1%, followed by membranous nephropathy (MN), with a frequency of 23.4%. Notably, the adjusted odds for MN increased 13% annually over the 11-year study period, whereas the proportions of other major glomerulopathies remained stable. During the study period, 3-year average PM exposure varied among the 282 cities, ranging from 6 to 114 μg/m (mean, 52.6 μg/m). Each 10 μg/m increase in PM concentration associated with 14% higher odds for MN (odds ratio, 1.14; 95% confidence interval, 1.10 to 1.18) in regions with PM concentration >70 μg/m We also found that higher 3-year average air quality index was associated with increased risk of MN. In conclusion, in this large renal biopsy series, the frequency of MN increased over the study period, and long-term exposure to high levels of PM was associated with an increased risk of MN.
空气污染对肾小球病变化模式的影响尚未得到研究。我们评估了2004年至2014年期间中国282个城市938家医院的11年肾活检系列中71151例原发性活检的肾小球疾病概况及时间变化，并研究了长期暴露于直径<2.5μm的细颗粒物（PM）与肾小球病的关联。在进行年龄和地区标准化后，我们确定IgA肾病是肾小球病的主要类型，发生率为28.1%，其次是膜性肾病（MN），发生率为23.4%。值得注意的是，在11年的研究期间，MN的校正比值每年增加13%，而其他主要肾小球病的比例保持稳定。在研究期间，282个城市的3年平均PM暴露量各不相同，范围为6至114μg/m³（平均52.6μg/m³）。在PM浓度>70μg/m³的地区，PM浓度每增加10μg/m³，MN的发病几率就会高出14%（比值比，1.14；95%置信区间，1.10至1.18）。我们还发现，3年平均空气质量指数越高，MN的风险就越高。总之，在这个大型肾活检系列中，MN的发生率在研究期间有所增加，长期暴露于高水平的PM与MN风险增加有关。
