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同时患有 IgA 肾病和膜性肾病,这是一种重叠综合征吗?

Concurrent IgA Nephropathy and Membranous Nephropathy, Is It an Overlap Syndrome?

机构信息

Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.

Renal Division, The Third People's Hospital of Zhengzhou, Zhengzhou, China.

出版信息

Front Immunol. 2022 Mar 11;13:846323. doi: 10.3389/fimmu.2022.846323. eCollection 2022.

Abstract

IgA nephropathy (IgAN) and membranous nephropathy (MN) are common glomerulonephritis, the presence of which in the same patient- concurrent of IgAN and MN (cIgAN/MN) has been described occasionally. This study aims to show clinical-pathological features of cIgAN/MN and attempts to suggest underlying pathogenesis using disease-specific biomarkers and a genomics approach. This retrospective cohort study described the clinical and pathological data from 137 patients with cIgAN/MN diagnosed in Peking University First Hospital from 2005 to 2019. One hundred primary IgAN and 100 MN cases were randomly selected as disease controls between the same time interval. Moreover, disease-specific biomarkers and polygenic risk score models were conducted to reveal the underlying pathogenesis. The median age of the cIgAN/MN cases was 45-year-old, and 46% were women. Compared to IgAN, patients with cIgAN/MN had a higher level of 24-hour proteinuria excretion but lower microscopic hematuria. They had a lower median level of galactose-deficient IgA1 (Gd-IgA1, 4.00 versus 5.45 μg/ml, =0.002) as well as the standardized genetic risk scores of developing IgAN (GRSs: 0.05 versus 0.68, <0.001). Compared to MN, patients with cIgAN/MN had a lower proportion of nephrotic syndrome and a lower level of albumin-to-creatinine ratio. However, the 24-hour proteinuria levels, serum lipid profiles, proportion of hypertension, and pathology classification were similar. Patients with cIgAN/MN had lower levels of plasma autoantibodies against the M-type transmembrane phospholipase A2 receptor (PLA2R) (11.23 versus 36.59 U/ml, =0.005). Intriguingly, there were no statistical differences in standardized GRSs of developing MN between them (2.77 versus 3.02, =0.326). Compared to IgAN, cIgAN/MN may lean towards MN more according to clinical-pathological features, disease-specific biomarker levels, and disease-specific genetic risk scores.

摘要

IgA 肾病 (IgAN) 和膜性肾病 (MN) 是常见的肾小球肾炎,同一患者同时存在 IgAN 和 MN(cIgAN/MN)的情况偶尔会被描述。本研究旨在展示 cIgAN/MN 的临床病理特征,并尝试使用疾病特异性生物标志物和基因组学方法来提示潜在的发病机制。这项回顾性队列研究描述了 2005 年至 2019 年期间北京大学第一医院诊断为 cIgAN/MN 的 137 例患者的临床和病理数据。在同一时间间隔内,随机选择了 100 例原发性 IgAN 和 100 例 MN 病例作为疾病对照。此外,还进行了疾病特异性生物标志物和多基因风险评分模型的检测,以揭示潜在的发病机制。cIgAN/MN 病例的中位年龄为 45 岁,46%为女性。与 IgAN 相比,cIgAN/MN 患者的 24 小时蛋白尿排泄量更高,但镜下血尿水平较低。cIgAN/MN 患者的半乳糖缺乏 IgA1(Gd-IgA1)水平中位数较低(4.00 与 5.45 μg/ml,=0.002),发生 IgAN 的标准化遗传风险评分(GRSs)也较低(0.05 与 0.68,<0.001)。与 MN 相比,cIgAN/MN 患者的肾病综合征比例较低,白蛋白与肌酐比值较低。然而,24 小时蛋白尿水平、血脂谱、高血压比例和病理分类相似。cIgAN/MN 患者血浆中针对 M 型跨膜磷脂酶 A2 受体(PLA2R)的自身抗体水平较低(11.23 与 36.59 U/ml,=0.005)。有趣的是,它们之间发生 MN 的标准化 GRSs 没有统计学差异(2.77 与 3.02,=0.326)。与 IgAN 相比,根据临床病理特征、疾病特异性生物标志物水平和疾病特异性遗传风险评分,cIgAN/MN 可能更倾向于 MN。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f1b1/8961684/d0f1926377cc/fimmu-13-846323-g001.jpg

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