Dong Lingqiu, Tan Jiaxing, Li Fangming, Wang Siqing, Jiang Zheng, Qin Aiya, Zhong Zhengxia, Zhou Xiaoyuan, Tang Yi, Qin Wei
West China School of Medicine, Sichuan University, Chengdu, China.
Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, China.
Front Med (Lausanne). 2021 Nov 17;8:761897. doi: 10.3389/fmed.2021.761897. eCollection 2021.
This study aimed to investigate the clinicopathological features and prognosis of immunoglobulin A nephropathy (IgAN) with arterial-arteriolar sclerosis (AS). Patients with biopsy-proven IgAN from the West China Hospital of Sichuan University were retrospectively enrolled. Clinicopathological features were collected. Patients were categorized based on the presence and the severity of the AS. All the patients were regularly followed-up until a composite end point. The correlation between AS and prognosis of IgAN was assessed. A total of 1,424 patients were recruited and followed for 60.0 ± 28.7 months. Patients with AS tended to have older age, higher blood pressure, heavier proteinuria, higher serum creatinine, uric acid, and total triglyceride (TG). Meanwhile, they were more likely to have a lower estimated glomerular filtration rate (eGFR), hemoglobin, and albumin. At the end of follow-up, 126 patients in the AS group and 47 patients in the non-AS group had reached the composite end point ( < 0.001). AS was associated with the renal outcome (log-rank < 0.001) and was an independent risk factor for the progression of IgAN ( = 0.049). The severity of AS was associated with renal outcomes (log-rank < 0.001) and there was a trend that it might serve as an independent risk marker for progression of IgAN. In the subgroup analysis, patients presenting with AS and lower eGFR, albumin, and hemoglobin or higher proteinuria, uric acid, and TG had a significant trend for a shorter time to reach the end point (log-rank < 0.001). AS was commonly seen in patients with IgAN and was independently associated with the poor prognosis.
本研究旨在探讨伴动脉-小动脉硬化（AS）的免疫球蛋白A肾病（IgAN）的临床病理特征及预后。回顾性纳入四川大学华西医院经活检证实为IgAN的患者。收集临床病理特征。根据AS的有无及严重程度对患者进行分类。所有患者均定期随访直至出现复合终点。评估AS与IgAN预后的相关性。共纳入1424例患者，随访时间为60.0±28.7个月。伴有AS的患者往往年龄较大、血压较高、蛋白尿较重、血清肌酐、尿酸及总甘油三酯（TG）较高。同时，他们更有可能估算肾小球滤过率（eGFR）、血红蛋白及白蛋白较低。随访结束时，AS组有126例患者、非AS组有47例患者达到复合终点（<0.001）。AS与肾脏结局相关（对数秩检验<0.001），并且是IgAN进展的独立危险因素（=0.049）。AS的严重程度与肾脏结局相关（对数秩检验<0.001），并且有趋势表明其可能作为IgAN进展的独立风险标志物。在亚组分析中，伴有AS且eGFR、白蛋白及血红蛋白较低或蛋白尿、尿酸及TG较高的患者达到终点的时间有显著缩短趋势（对数秩检验<0.001）。AS在IgAN患者中常见，且与不良预后独立相关。
