Zhang Ji, Chen Chaosheng, Zhou Qiongxiu, Zheng Shubei, Lv Yinqiu, Zhang Jianna, You Xiaohan, Li Zhanyuan, Zhou Zhihong, Pan Min
Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China.
Department of Nephrology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China.
Oncotarget. 2017 Oct 9;8(58):99125-99135. doi: 10.18632/oncotarget.21702. eCollection 2017 Nov 17.
IgA nephropathy is a primary cause of renal failure, and inflammation and renal fibrosis are the main mechanisms leading to kidney damage. The serum fibrinogen level is closely related to inflammatory states, but its relationship to the prognosis of IgA nephropathy (IgAN) is unclear.
1053 patients diagnosed with IgAN after renal biopsy were enrolled from two Nephrology Departments. Demographic and clinical data and histopathological features were collected. The patients were divided into four groups (Q1-Q4) according to the serum fibrinogen levels at the time of renal biopsy, and the relationships of serum fibrinogen levels with other risk factors and the prognosis of IgAN were investigated.
672 patients with proven primary IgAN were included in this study, which included a median follow-up of 36 months. Patients with higher serum fibrinogen levels had elevated serum creatinine levels, 24-hour urinary protein, and blood pressure compared with patients with the lowest levels of serum fibrinogen as well as severe renal damage at the time of renal biopsy. Univariate and multivariate Cox regression analyses confirmed that the serum fibrinogen level at the time of renal biopsy was significantly related to the prognosis of patients with IgAN.
In patients with IgAN, an elevated serum fibrinogen level at the time of renal biopsy is associated with poor renal outcomes, which suggests the need for more aggressive early interventions. Greater benefits of aggressive treatments were observed in patients with higher serum fibrinogen levels.
IgA肾病是肾衰竭的主要病因，炎症和肾纤维化是导致肾脏损伤的主要机制。血清纤维蛋白原水平与炎症状态密切相关，但其与IgA肾病（IgAN）预后的关系尚不清楚。
从两个肾病科招募了1053例经肾活检确诊为IgAN的患者。收集人口统计学和临床资料以及组织病理学特征。根据肾活检时的血清纤维蛋白原水平将患者分为四组（Q1-Q4），并研究血清纤维蛋白原水平与其他危险因素及IgAN预后的关系。
本研究纳入672例确诊为原发性IgAN的患者，中位随访时间为36个月。与血清纤维蛋白原水平最低的患者相比，血清纤维蛋白原水平较高的患者血清肌酐水平、24小时尿蛋白和血压升高，且肾活检时存在严重肾损伤。单因素和多因素Cox回归分析证实，肾活检时的血清纤维蛋白原水平与IgAN患者的预后显著相关。
在IgAN患者中，肾活检时血清纤维蛋白原水平升高与不良肾脏结局相关，这表明需要更积极的早期干预。在血清纤维蛋白原水平较高的患者中观察到积极治疗有更大益处。
