高胆固醇血症与肾小球磷脂酶 A2 受体沉积及血清抗磷脂酶 A2 受体抗体相关，并可预测特发性膜性肾病的蛋白尿转归。
Hypercholesterolemia Correlates With Glomerular Phospholipase A2 Receptor Deposit and Serum Anti-Phospholipase A2 Receptor Antibody and Predicts Proteinuria Outcome in Idiopathic Membranous Nephropathy.
机构信息
Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Front Immunol. 2022 Jun 17;13:905930. doi: 10.3389/fimmu.2022.905930. eCollection 2022.
BACKGROUND
The anti-phospholipase A2 receptor (PLA2R) antibody is a non-invasive diagnostic tool and prognosis predictor of idiopathic membranous nephropathy (IMN). Baseline hypercholesterolemia independently predicts proteinuria outcomes in IMN patients. Thus, we investigated whether hyperlipidemia is correlated with anti-PLA2R and pathological indicators.
METHODS
A total of 495 IMN patients identified by kidney biopsy in Wuhan Tongji Hospital, China, from January 2016 through December 2020 were enrolled in this study. Data on clinical features, pathology findings, and outcomes were collected.
RESULTS
Total cholesterol (TC), non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) were positively related to proteinuria, indicating damage to the renal glomerulus [Spearman's rank correlation coefficient = 0.432, 0.462, 0.315, and 0.289, respectively, < 0.001 for all]. In univariate logistic regression, low HDL-C [odds ratio (OR): 0.856; 95% CI: 0.778-0.939; = 0.001] and high TG [OR: 1.025; 95% CI: 1.006-1.044; = 0.011] were correlated with tubular atrophy, suggesting lesions on tubules. Increased TC [adjusted OR: 1.285; 95% CI: 1.119-1.475; < 0.001], non-HDL-C [adjusted OR: 1.284; 95% CI: 1.113-1.482; = 0.001], and LDL-C [adjusted OR: 1.178; 95% CI: 1.009-1.376; = 0.039] independently predicted glomerular PLA2R deposit; similar results were observed for lipids in predicting the seropositivity of anti-PLA2R antibodies. After treatment, increased HDL-C [adjusted hazard ratio (HR): 1.764; 95% CI: 1.241-2.507; = 0.002] and decreased non-HDL-C [adjusted HR: 0.884; 95% CI: 0.795-0.983; = 0.022] independently predicted proteinuria remission.
CONCLUSION
Hypercholesterolemia is a potentially useful biomarker for disease severity, serum anti-PLA2R antibody, glomerular PLA2R deposit, and proteinuria outcome of IMN.
背景
抗磷酯酶 A2 受体（PLA2R）抗体是特发性膜性肾病（IMN）的一种非侵入性诊断工具和预后预测指标。基线高胆固醇血症独立预测 IMN 患者的蛋白尿结局。因此，我们研究了高脂血症是否与抗 PLA2R 和病理指标相关。
方法
本研究共纳入 2016 年 1 月至 2020 年 12 月在中国武汉同济医院通过肾脏活检确诊的 495 例 IMN 患者。收集临床特征、病理发现和结局数据。
结果
总胆固醇（TC）、非高密度脂蛋白胆固醇（non-HDL-C）、低密度脂蛋白胆固醇（LDL-C）和甘油三酯（TG）与蛋白尿呈正相关，表明肾小球损伤[Spearman 秩相关系数分别为 0.432、0.462、0.315 和 0.289，均<0.001]。单因素 logistic 回归显示，低 HDL-C[比值比（OR）：0.856；95%置信区间（CI）：0.778-0.939； = 0.001]和高 TG[OR：1.025；95% CI：1.006-1.044； = 0.011]与肾小管萎缩相关，提示肾小管病变。TC 升高[校正 OR：1.285；95% CI：1.119-1.475；<0.001]、non-HDL-C[校正 OR：1.284；95% CI：1.113-1.482； = 0.001]和 LDL-C[校正 OR：1.178；95% CI：1.009-1.376； = 0.039]独立预测肾小球 PLA2R 沉积；脂质对预测抗 PLA2R 抗体的血清阳性率也有类似的结果。治疗后，HDL-C 升高[校正风险比（HR）：1.764；95% CI：1.241-2.507； = 0.002]和 non-HDL-C 降低[校正 HR：0.884；95% CI：0.795-0.983； = 0.022]独立预测蛋白尿缓解。
结论
高胆固醇血症是 IMN 疾病严重程度、血清抗 PLA2R 抗体、肾小球 PLA2R 沉积和蛋白尿结局的一个潜在有用的生物标志物。
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