Tsai Shang-Feng, Wu Ming-Ju, Wen Mei-Chin, Chen Cheng-Hsu
Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan.
Department of Life Science, Tunghai University, Taichung 407, Taiwan.
J Clin Med. 2019 Jun 14;8(6):848. doi: 10.3390/jcm8060848.
: The Haas classification of IgA nephropathy should be validated for Asian populations. More detailed and newer predictions regarding renal outcome of IgA nephropathy remains mandatory. : We conducted a retrospective cohort study between January 2003 and December 2013. Clinical, Pathological, and laboratory data were all collected via available medical records. A Mann-Whitney U test was used for continuous variables and the Chi-square test was implemented for categorical variables. A Kaplan-Meier curve was put in place in order to determine patient survival and renal survival. The Youden index and Cox proportional hazard regression were used to investigate the possible factors for renal survival and predictive power. : All 272 renal biopsy-confirmed IgAN patients were enrolled for further studies. The univariate analysis showed that risk factors for poor renal outcome included stage 4-5 of Haas classification (HR = 3.67, < 0.001), a poor baseline renal function (HR = 1.02 and < 0.001 for higher BUN; HR = 1.14 and < 0.001 for higher serum creatinine; HR = 0.95, < 0.001 for higher eGFR), IgG ≤ 907 (HR = 2.29, = 0.003), C3 ≤ 79.7 (HR = 2.76, = 0.002), a higher C4 (HR = 1.02, = 0.026), neutrophil-to-lymphocyte ratio > 2.75 (HR = 2.92, < 0.001), and a platelet-to-lymphocyte ratio ≥ 16.06 (HR = 2.02, = 0.012). A routine-checked markers, such as neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio, in order to predict the renal outcome, is recommended. : This is the first study to demonstrate that Haas classification is also useful for establishing predictive values in Asian groups. A lower serum IgG (≤907 mg/dL) and serum C3 (≤79.7 mg/dL) were both risk factors for poor renal outcome. Additionally, this is the first study to reveal that serum C4 levels, an NLR > 2.75 and a PLR > 16.06, S could suggest poor renal outcome.
IgA肾病的哈斯分类应在亚洲人群中进行验证。关于IgA肾病肾脏预后更详细和更新的预测仍然是必要的。
我们在2003年1月至2013年12月期间进行了一项回顾性队列研究。临床、病理和实验室数据均通过现有病历收集。连续变量采用曼-惠特尼U检验，分类变量采用卡方检验。绘制了Kaplan-Meier曲线以确定患者生存率和肾脏生存率。使用约登指数和Cox比例风险回归来研究肾脏生存的可能因素和预测能力。
所有272例经肾活检确诊的IgA肾病患者均纳入进一步研究。单因素分析表明，肾脏预后不良的危险因素包括哈斯分类的4-5期（HR = 3.67，<0.001）、基线肾功能差（较高的BUN时HR = 1.02，<0.001；较高的血清肌酐时HR = 1.14，<0.001；较高的eGFR时HR = 0.95，<0.001）、IgG≤907（HR = 2.29，= 0.003）、C3≤79.7（HR = 2.76，= 0.002）、较高的C4（HR = 1.02，= 0.026）、中性粒细胞与淋巴细胞比值>2.75（HR = 2.92，<0.001）以及血小板与淋巴细胞比值≥16.06（HR = 2.02，= 0.012）。建议使用中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值等常规检查指标来预测肾脏预后。
这是第一项证明哈斯分类在亚洲人群中也有助于建立预测价值的研究。较低的血清IgG（≤907mg/dL）和血清C3（≤79.7mg/dL）都是肾脏预后不良的危险因素。此外，这是第一项揭示血清C4水平、NLR>2.75和PLR>16.06可能提示肾脏预后不良的研究。
