Li Qianqian, Chen Ping, Shi Sufang, Liu Lijun, Lv Jicheng, Zhu Li, Zhang Hong
Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, China.
Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, China; Renal Division, The Affiliated People's Hospital of Shanxi Medical University, Shanxi Provincial People's Hospital, China.
Int Immunopharmacol. 2020 Oct;87:106811. doi: 10.1016/j.intimp.2020.106811. Epub 2020 Jul 22.
IgA nephropathy (IgAN) is achronic immuno-inflammatory progressive disease. Several systemic inflammatory indicators, mainly the neutrophil-to-lymphocyte ratio (NLR), are regarded as valuable markers for many diseases, such as IgA vasculitis and chronic kidney disease. Here, we investigated multiple peripheral blood indicators in a large IgAN registry with regular follow-up to evaluate their effects on IgAN phenotypes and progression.
Totally, 1151 IgAN patients with regular follow-up, and 251 healthy volunteers were enrolled. Complete blood count test results, including counts of white blood cells (WBC), neutrophils (NE), lymphocyte (LY), and platelets (PLT), were collected from medical records. Then, NLR and PLR were calculated.
IgAN patients presented with increased WBC, NE, NLR and PLR levels and decreased LY levels compared with controls. In univariate survival analysis, WBC, NE and NLR showed significant associations with IgAN progression, and NLR had a higher area under the ROC curves than NE and WBC. When adjusted for well-known risk factors, NLR remained an independent risk factor for poor renal outcome in IgAN patients and performed better than NE. By using NLR 2.40 as cutoff point, IgAN patients were divided into two groups. IgAN patients in the high NLR group presented with lower eGFR, higher proteinuria, higher incidence of hypertension, and more severe pathological lesions, as well as lower event-free renal survival rate.
We found patients with IgAN had elevated NLR levels than healthy controls, and the easily available NLR in clinical practice could serve as an independent risk factor for IgAN progression.
IgA肾病（IgAN）是一种慢性免疫炎症性进展性疾病。几种全身炎症指标，主要是中性粒细胞与淋巴细胞比值（NLR），被认为是许多疾病的有价值标志物，如IgA血管炎和慢性肾脏病。在此，我们在一个进行定期随访的大型IgA肾病登记处研究了多种外周血指标，以评估它们对IgA肾病表型和进展的影响。
共纳入1151例进行定期随访的IgA肾病患者和251名健康志愿者。从病历中收集全血细胞计数测试结果，包括白细胞（WBC）、中性粒细胞（NE）、淋巴细胞（LY）和血小板（PLT）计数。然后计算NLR和PLR。
与对照组相比，IgA肾病患者的WBC、NE、NLR和PLR水平升高，LY水平降低。在单因素生存分析中，WBC、NE和NLR与IgA肾病进展显著相关，且NLR的ROC曲线下面积高于NE和WBC。在对已知危险因素进行校正后，NLR仍然是IgA肾病患者肾脏预后不良的独立危险因素，且比NE表现更好。以NLR 2.40为截断点，将IgA肾病患者分为两组。高NLR组的IgA肾病患者eGFR较低、蛋白尿较高、高血压发病率较高、病理病变较严重，且无事件肾脏生存率较低。
我们发现IgA肾病患者的NLR水平高于健康对照组，临床实践中易于获得的NLR可作为IgA肾病进展的独立危险因素。
