基于倾向评分匹配的血清 C3/C4 比值与免疫球蛋白 A 肾病预后的关系。

Relationship between serum C3/C4 ratio and prognosis of immunoglobulin A nephropathy based on propensity score matching.

机构信息

Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China.

出版信息

Chin Med J (Engl). 2020 Mar 20;133(6):631-637. doi: 10.1097/CM9.0000000000000674.

DOI:10.1097/CM9.0000000000000674

PMID:32068601

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7190234/

Abstract

BACKGROUND

Aberrant activation of the complement system plays an important role in the pathogenesis and development of immunoglobulin A nephropathy (IgAN). The relationship between serum complement and the clinical-histopathological features and outcomes of IgAN is controversial. This retrospective study aimed to examine the relationship between the complement 3/4 (C3/C4) ratio and the clinicopathologic changes and prognosis of patients with IgAN.

METHODS

A total of 397 patients with primary IgAN from January 2007 to December 2012 at the Chinese People's Liberation Army General Hospital were included in this study. The correlation test and Chi-square test or one-way analysis of variance test were performed to evaluate the relationship between the C3/C4 ratio and other clinical-pathological factors. Propensity score matching and a multivariate Cox regression model were used to calculate the risk factors of renal outcome.

RESULTS

The median follow-up period was 75 months. During the follow-up period, 62 patients (15.6%) developed into the end-stage renal disease (ESRD). The C3/C4 ratio at baseline was associated with the level of serum creatinine (SCr), 24 h urinary protein excretion (24 h Upre), global glomerular sclerosis, and tubulointerstitial lesion. The level of SCr and 24 h Upre and the degree of chronic kidney injury were statistically different among groups defined by different C3/C4 ratio levels. The survival rates of patients among groups with different C3/C4 ratio levels were different. After propensity score matching, eighty-eight pairs of patients were successfully matched, and the C3/C4 ratio was an influencing factor for the patients' outcome (hazard ratio 0.587, 95% confidence interval 0.329-0.880). Patients with a C3/C4 ratio <3.6 had a poorer outcome compared with the others (P = 0.002).

CONCLUSIONS

IgAN patients with decreased C3/C4 ratio displayed significantly more severe clinical symptoms and chronic renal injury than patients with higher ratios. A low C3/C4 ratio could be a risk factor for patients developing to ESRD.

摘要

背景

补体系统的异常激活在免疫球蛋白 A 肾病（IgAN）的发病机制和发展中起着重要作用。血清补体与 IgAN 的临床-组织病理学特征和结局之间的关系存在争议。本回顾性研究旨在探讨补体 3/4（C3/C4）比值与 IgAN 患者的临床病理变化及预后的关系。

方法

本研究共纳入 2007 年 1 月至 2012 年 12 月期间在中国人民解放军总医院就诊的 397 例原发性 IgAN 患者。采用相关检验和卡方检验或单因素方差分析检验 C3/C4 比值与其他临床病理因素之间的关系。采用倾向评分匹配和多因素 Cox 回归模型计算肾脏结局的危险因素。

结果

中位随访时间为 75 个月。随访期间，62 例（15.6%）患者进展至终末期肾病（ESRD）。基线时的 C3/C4 比值与血清肌酐（SCr）、24 小时尿蛋白排泄量（24 h Upre）、全球肾小球硬化和肾小管间质病变水平相关。根据不同 C3/C4 比值水平定义的各组之间，SCr 水平和 24 h Upre 以及慢性肾损伤程度存在统计学差异。不同 C3/C4 比值水平组的患者生存率不同。经过倾向评分匹配，88 对患者成功匹配，C3/C4 比值是影响患者预后的因素（危险比 0.587，95%置信区间 0.329-0.880）。C3/C4 比值<3.6 的患者预后较差，与其他患者相比差异有统计学意义（P = 0.002）。