Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China.
J Nephrol. 2021 Dec;34(6):1887-1896. doi: 10.1007/s40620-021-01004-2. Epub 2021 Mar 8.
Hepatitis B virus (HBV) infections are associated with an increased risk of kidney diseases. However, the effects of HBV infection on the prognosis of immunoglobulin A nephropathy (IgAN) are unclear.
A total of 838 patients with biopsy-confirmed IgAN were enrolled in this retrospective cohort study. The patients were categorized into either affected by IgAN and HBV infection (HBsAg-IgAN) or by primary IgAN with no sign of HBV infection (P-IgAN). A 1:1 propensity-score matching was performed between the two groups, followed by a Kaplan-Meier survival analysis, to compare the prognoses, and a Cox regression analysis, to identify factors influencing the HBsAg-IgAN outcomes.
A total of 176 pairs of patients were successfully matched. A significant difference in the systolic blood pressure and urea, serum creatinine, uric acid, and 24-h urine protein levels was observed between the groups. A renal pathological analysis also revealed a significant difference in the mesangial hypercellularity between the groups. During a median follow-up period of 2.4 years, Kaplan-Meier analysis also revealed a significant difference in the renal survival between the groups. Furthermore, multivariate Cox analysis confirmed that HBV infection is an independent risk factor for IgAN progression (hazard ratio [HR] 2.096; 95% confidence interval [CI] 1.091-4.026). Finally, the HBsAg-IgAN patients who received treatment with renin-angiotensin-aldosterone system inhibitors had a better overall prognosis than those who received immunosuppressive therapy and antiviral treatment.
Our results indicate that the clinicopathological features and outcomes of patients with IgAN differ significantly between those with and without HBV infection, and that HBV is an independent risk factor for IgAN progression.
乙型肝炎病毒 (HBV) 感染与肾脏疾病风险增加相关。然而，HBV 感染对免疫球蛋白 A 肾病 (IgAN) 预后的影响尚不清楚。
本回顾性队列研究共纳入 838 例经活检证实的 IgAN 患者。将患者分为合并 HBV 感染的 IgAN 组（HBsAg-IgAN）和无 HBV 感染的原发性 IgAN 组（P-IgAN）。对两组进行 1:1 倾向评分匹配，然后进行 Kaplan-Meier 生存分析以比较预后，并进行 Cox 回归分析以确定影响 HBsAg-IgAN 结局的因素。
共成功匹配了 176 对患者。两组间的收缩压和尿素、血清肌酐、尿酸和 24 小时尿蛋白水平存在显著差异。肾脏病理分析还显示两组间系膜细胞增生存在显著差异。在中位随访 2.4 年期间，Kaplan-Meier 分析也显示两组间的肾脏生存率存在显著差异。此外，多变量 Cox 分析证实 HBV 感染是 IgAN 进展的独立危险因素（危险比 [HR] 2.096；95%置信区间 [CI] 1.091-4.026）。最后，接受肾素-血管紧张素-醛固酮系统抑制剂治疗的 HBsAg-IgAN 患者的总体预后优于接受免疫抑制治疗和抗病毒治疗的患者。
我们的结果表明，HBV 感染与无 HBV 感染的 IgAN 患者的临床病理特征和结局存在显著差异，HBV 是 IgAN 进展的独立危险因素。
