West China School of Medicine, Sichuan University, Chengdu, China.
Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, China.
Front Immunol. 2021 Aug 12;12:700224. doi: 10.3389/fimmu.2021.700224. eCollection 2021.
Complex factors are involved in the development and progression of immunoglobulin A nephropathy (IgAN), a common primary glomerulonephritis worldwide. Autoimmunity and inflammation have been considered to be the basic mechanisms; however, the exact pathogenesis remains unclear. As a novel marker of inflammation, the neutrophil-to-lymphocyte ratio (NLR) has been studied in various diseases. Whether the NLR can predict the renal outcome of patients with IgAN remains unclear. We evaluated the relationships between the NLR and renal function, pathologic lesions, renal progression, and prognosis in patients with IgAN.
This retrospective study involved 966 patients with biopsy-proven IgAN. They were divided into two groups based on the cut-off value of the NLR: the high group (NLR ≥ 2.67, n = 384) and the low group (NLR < 2.67, n = 582). The endpoint was end-stage renal disease [estimated glomerular filtration rate (eGFR) of <15 mL/min/1.73 m or performance of renal replacement therapy]. A correlation test was conducted to explore the relationship between the NLR and other important parameters (eGFR, serum creatinine, proteinuria, hypertension and renal pathologic lesions). The predictive value was determined by the area under the receiver operating characteristics curve (AUROC). Kaplan-Meier and Cox proportional hazards analyses were performed to evaluate renal progression and prognosis.
The NLR had the highest AUROC, which was 0.633 (p < 0.001). The correlation test revealed that the NLR was positively correlated with serum creatinine (r = 0.127, p < 0.001) and 24-hour urine protein (r = 0.18, p < 0.001) and negatively correlated with eGFR (r = 0.14, p < 0.001). Patients with IgAN who had a high NLR were more likely to have hypertension (p = 0.003). Multivariate Cox regression analysis indicated that a high NLR was an independent risk factor for IgAN even after adjustment for important clinical and pathological parameters (p = 0.043, HR = 1.74, 95%CI: 1.02-2.97). Kaplan-Meier analysis showed that a high NLR was significantly associated with the renal prognosis of patients with IgAN (p < 0.001), especially patients with stage 3 to 4 chronic kidney disease (p = 0.028) or 24-hour urine protein of >1 g/day (p < 0.001).
An elevated NLR affects the renal progression and prognosis in patients with IgAN and could be a marker for evaluation of renal function and pathologic lesions.
免疫球蛋白 A 肾病（IgAN）是一种常见的原发性肾小球肾炎，其发生和发展涉及复杂的因素。自身免疫和炎症被认为是基本机制；然而，确切的发病机制尚不清楚。中性粒细胞与淋巴细胞比值（NLR）作为一种新的炎症标志物，已在多种疾病中进行了研究。NLR 是否可以预测 IgAN 患者的肾脏预后尚不清楚。我们评估了 NLR 与 IgAN 患者肾功能、病理损伤、肾脏进展和预后之间的关系。
本回顾性研究纳入了 966 例经活检证实的 IgAN 患者。根据 NLR 的截断值将患者分为两组：高组（NLR≥2.67，n=384）和低组（NLR<2.67，n=582）。终点为终末期肾病[估计肾小球滤过率（eGFR）<15 mL/min/1.73 m 或进行肾脏替代治疗]。采用相关检验探讨 NLR 与其他重要参数（eGFR、血清肌酐、蛋白尿、高血压和肾脏病理损伤）之间的关系。通过受试者工作特征曲线（AUROC）下面积确定预测价值。采用 Kaplan-Meier 和 Cox 比例风险分析评估肾脏进展和预后。
NLR 的 AUROC 最高，为 0.633（p<0.001）。相关检验显示，NLR 与血清肌酐（r=0.127，p<0.001）和 24 小时尿蛋白（r=0.18，p<0.001）呈正相关，与 eGFR 呈负相关（r=-0.14，p<0.001）。NLR 较高的 IgAN 患者更易发生高血压（p=0.003）。多变量 Cox 回归分析表明，NLR 升高是 IgAN 的独立危险因素，即使在调整了重要的临床和病理参数后也是如此（p=0.043，HR=1.74，95%CI：1.02-2.97）。Kaplan-Meier 分析显示，NLR 升高与 IgAN 患者的肾脏预后显著相关（p<0.001），尤其是慢性肾脏病 3 至 4 期（p=0.028）或 24 小时尿蛋白>1 g/天（p<0.001）的患者。
升高的 NLR 影响 IgAN 患者的肾脏进展和预后，可作为评估肾功能和病理损伤的标志物。
