Zhang Ti, Yang Fan, Zuo Ke, Wang Jinquan, Cheng Zhen, Zhang Jiong
National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Front Med (Lausanne). 2020 Apr 7;7:89. doi: 10.3389/fmed.2020.00089. eCollection 2020.
This study aimed to determine the impact of HLA-B27 on clinical phenotype and renal function during follow-up periods in patients with ankylosing spondylitis (AS) and secondary IgA nephropathy (IgAN). This single-center retrospective study included 71 AS patients with secondary IgAN. Renal function decline was defined as a mean eGFR decline of more than 5 mL/min/1.73 m per year or progression into the dialysis stage. The association between HLA-B27 status and renal function decline was evaluated by univariable and multivariable Cox regression analyses. The results showed that seven (9.85%) of the 71 included patients were HLA-B27-negative. The median follow-up period was 4.0 years. HLA-B27-negative patients showed higher levels of uric acid (UA) than those who were HLA-B27-positive. Pathologically, a higher percentage of globally sclerotic glomeruli was observed in HLA-B27-negative patients. Survival analysis indicated that HLA-B27 negativity was associated with a significantly higher probability of renal function decline than HLA-B27 positivity. This significant association was also found in subgroup analyses of patients with either substantial proteinuria (more than 1.0 g per day) or interstitial fibrosis and tubular atrophy. Multivariable analysis showed that HLA-27 negativity was independently associated with renal function decline (HR 6.58; 95% CI 1.65 to 26.21; = 0.008). In conclusion, HLA-B27 negativity is associated not only with a higher level of UA and a higher percentage of globally sclerotic glomeruli in AS patients with secondary IgAN but with renal function decline during follow-up periods.
本研究旨在确定人类白细胞抗原B27（HLA - B27）对强直性脊柱炎（AS）合并继发性IgA肾病（IgAN）患者随访期间临床表型及肾功能的影响。这项单中心回顾性研究纳入了71例AS合并继发性IgAN患者。肾功能下降定义为估算肾小球滤过率（eGFR）平均每年下降超过5 mL/min/1.73 m²或进展至透析阶段。通过单变量和多变量Cox回归分析评估HLA - B27状态与肾功能下降之间的关联。结果显示，纳入的71例患者中有7例（9.85%）为HLA - B27阴性。中位随访期为4.0年。HLA - B27阴性患者的尿酸（UA）水平高于HLA - B27阳性患者。病理检查发现，HLA - B27阴性患者中全球硬化性肾小球的比例更高。生存分析表明，与HLA - B27阳性相比，HLA - B27阴性患者肾功能下降的概率显著更高。在大量蛋白尿（每天超过1.0 g）或间质纤维化和肾小管萎缩患者的亚组分析中也发现了这种显著关联。多变量分析显示，HLA - 27阴性与肾功能下降独立相关（风险比6.58；95%置信区间1.65至26.21；P = 0.008）。总之，HLA - B27阴性不仅与AS合并继发性IgAN患者的较高UA水平和较高比例的全球硬化性肾小球有关，还与随访期间的肾功能下降有关。
