Wang Zu-Feng, Cheng Yi-Chun, Li Yue-Qiang, Liu Liu, Ge Shu-Wang, Xu Gang
Division of Internal Medicine, Department of Nephrology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
Front Med (Lausanne). 2022 Feb 8;8:803929. doi: 10.3389/fmed.2021.803929. eCollection 2021.
Tertiary lymphoid organs play an essential role in the inflammation of the kidney. The clinical association between TLOs and membranous nephropathy (MN) is not clear yet.
Consecutive patients with the histologically confirmed membranous nephropathy in Tongji Hospital from July 19, 2012, to September 26, 2019, were included in this study. TLOs in renal biopsy tissues were detected by periodic acid-Schiff-stained and immunohistochemistry. Logistic regression was performed to evaluate the correlations of TLOs and clinical features of patients with MN. Kaplan-Meier analysis was utilized to examine the relationship between TLOs and remission of proteinuria.
A total of 442 patients with MN were included in this study, of which the average age was 46.4 years old, and 58.8% were male. Moreover, 33% of patients with MN had TLOs in this study. The median value of proteinuria among patients with MN with TLOs was 4.9 g/24 h, which was much greater than no-TLOs ones (3.2 g/24 h, < 0.001). Moreover, the patients with TLOs had higher serum creatinine and lower serum albumin. The severity of clinical features among the patients with MN aggravated with the increase in the grade of TLOs. In addition, the patients who had TLOs were more likely to be positive of anti-phospholipase A2 receptor autoantibodies. Meanwhile, the patients without TLOs showed significantly higher complete remission and total remission of proteinuria.
In this study, we demonstrated that TLOs were common among patients with MN. Moreover, the patients with MN with TLOs showed a worse clinical manifestation and an outcome compared with the patients without TLOs.
三级淋巴器官在肾脏炎症中起重要作用。三级淋巴器官（TLOs）与膜性肾病（MN）之间的临床关联尚不清楚。
本研究纳入了2012年7月19日至2019年9月26日在同济医院经组织学确诊为膜性肾病的连续患者。通过高碘酸-希夫染色和免疫组织化学检测肾活检组织中的TLOs。进行逻辑回归以评估TLOs与MN患者临床特征的相关性。采用Kaplan-Meier分析来检验TLOs与蛋白尿缓解之间的关系。
本研究共纳入442例MN患者，平均年龄46.4岁，男性占58.8%。此外，本研究中33%的MN患者有TLOs。有TLOs的MN患者蛋白尿中位数为4.9 g/24 h，远高于无TLOs的患者（3.2 g/24 h，P<0.001）。此外，有TLOs的患者血清肌酐较高，血清白蛋白较低。MN患者的临床特征严重程度随TLOs分级增加而加重。此外，有TLOs的患者抗磷脂酶A2受体自身抗体更易呈阳性。同时，无TLOs的患者蛋白尿完全缓解和总缓解率显著更高。
在本研究中，我们证明TLOs在MN患者中很常见。此外，与无TLOs的患者相比，有TLOs的MN患者临床表现和预后更差。
