一项多中心、前瞻性、观察性研究，旨在确定 IgA 肾病中系膜 C1q 沉积与肾脏结局的关系。
A multicenter, prospective, observational study to determine association of mesangial C1q deposition with renal outcomes in IgA nephropathy.
机构信息
Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
出版信息
Sci Rep. 2021 Mar 9;11(1):5467. doi: 10.1038/s41598-021-84715-7.
It was reported that histopathologic lesions are risk factors for the progression of IgA Nephropathy (IgAN). The aim of this study was to investigate the relationships between mesangial deposition of C1q and renal outcomes in IgAN. 1071 patients with primary IgAN diagnosed by renal biopsy were enrolled in multiple study centers form January 2013 to January 2017. Patients were divided into two groups: C1q-positive and C1q-negative. Using a 1: 4 propensity score matching (PSM) method identifying age, gender, and treatment modality to minimize confounding factors, 580 matched (out of 926) C1q-negative patients were compared with 145 C1q-positive patients to evaluate severity of baseline clinicopathological features and renal outcome. Kaplan-Meier and Cox proportional hazards analyses were performed to determine whether mesangial C1q deposition is associated with renal outcomes in IgAN. During the follow-up period (41.89 ± 22.85 months), 54 (9.31%) patients in the C1q negative group and 23 (15.86%) patients in C1q positive group reached the endpoint (50% decline of eGFR and/or ESRD or death) respectively (p = 0.01) in the matched cohort. Significantly more patients in C1q negative group achieved complete or partial remission during the follow up period (P = 0.003) both before and after PSM. Three, 5 and 7-year renal survival rates in C1q-positive patients were significantly lower than C1q-negative patients in either unmatched cohort or matched cohort (all p < 0.05). Furthermore, multivariate Cox regression analysis showed that independent risk factors influencing renal survival included Scr, urinary protein, T1-T2 lesion and C1q deposition. Mesangial C1q deposition is a predictor of poor renal survival in IgA nephropathy.Trial registration TCTR, TCTR20140515001. Registered May 15, 2014, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=1074 .
据报道，组织病理学病变是 IgA 肾病（IgAN）进展的危险因素。本研究旨在探讨 IgAN 中系膜 C1q 沉积与肾脏结局的关系。2013 年 1 月至 2017 年 1 月，在多个研究中心纳入了 1071 例经肾活检诊断为原发性 IgAN 的患者。将患者分为 C1q 阳性组和 C1q 阴性组。采用 1:4 倾向评分匹配（PSM）方法，识别年龄、性别和治疗方式，以尽量减少混杂因素，将 926 例 C1q 阴性患者中的 580 例（占 62.7%）与 145 例 C1q 阳性患者相匹配，以评估基线临床病理特征和肾脏结局的严重程度。采用 Kaplan-Meier 和 Cox 比例风险分析评估系膜 C1q 沉积与 IgAN 肾脏结局的关系。在随访期间（41.89±22.85 个月），C1q 阴性组 54 例（9.31%）和 C1q 阳性组 23 例（15.86%）患者分别达到终点（eGFR 下降 50%和/或 ESRD 或死亡）（p=0.01）在匹配队列中。在随访期间，C1q 阴性组的完全或部分缓解患者比例明显高于 C1q 阳性组（p=0.003），且无论在 PSM 前后均如此。在未匹配队列或匹配队列中，C1q 阳性患者的 3、5 和 7 年肾脏生存率均明显低于 C1q 阴性患者（均 p<0.05）。此外，多变量 Cox 回归分析显示，影响肾脏生存的独立危险因素包括 Scr、尿蛋白、T1-T2 病变和 C1q 沉积。系膜 C1q 沉积是 IgA 肾病患者不良肾脏预后的预测因子。试验注册 TCTR，TCTR20140515001。于 2014 年 5 月 15 日注册，网址：http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=1074。
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