Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China; Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Zhejiang, China.
Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Kidney Int. 2022 Dec;102(6):1382-1391. doi: 10.1016/j.kint.2022.08.020. Epub 2022 Sep 8.
IgA nephropathy (IgAN) is characterized by deposition of galactose-deficient IgA1 (Gd-IgA1) in glomerular mesangium associated with mucosal immune disorders. Since environmental pollution has been associated with the progression of chronic kidney disease in the general population, we specifically investigated the influence of exposure to fine particulate matter less than 2.5 μm in diameter (PM2.5) on IgAN progression. Patients with biopsy-proven primary IgAN were recruited from seven Chinese kidney centers. PM2.5 exposure from 1998 to 2016 was derived from satellite aerosol optical depth data and a total of 1,979 patients with IgAN, including 994 males were enrolled. The PM2.5 exposure levels for patients from different provinces varied but, in general, the PM2.5 exposure levels among patients from the north were higher than those among patients from the south. The severity of PM2.5 exposure in different regions was correlated with regional kidney failure burden. In addition, each 10 μg/m increase in annual average concentration of PM2.5 exposure before study entry (Hazard Ratio, 1.14; 95% confidence interval, 1.06-1.22) or time-varying PM2.5 exposure after study entry (1.10; 1.01-1.18) were associated with increased kidney failure risk after adjustment for age, gender, estimated glomerular filtration rate, urine protein, uric acid, hemoglobin, mean arterial pressure, Oxford classification, glucocorticoid and renin-angiotensin system blocker therapy. The associations were robust when the time period, risk factors of cardiovascular diseases or city size were further adjusted on the basis of the above model. Thus, our results suggest that PM2.5 is an independent risk factor for kidney failure in patients with IgAN, but these findings will require validation in more diverse populations and other geographic regions.
IgA 肾病（IgAN）的特征是在肾小球系膜中沉积半乳糖缺乏的 IgA1（Gd-IgA1），同时伴有黏膜免疫紊乱。由于环境污染与普通人群慢性肾脏病的进展有关，我们特别研究了细颗粒物（直径小于 2.5μm 的 PM2.5）暴露对 IgAN 进展的影响。从中国的七个肾病中心招募了经活检证实的原发性 IgAN 患者。从卫星气溶胶光学深度数据中得出了 1998 年至 2016 年的 PM2.5 暴露情况，共纳入 1979 例 IgAN 患者，包括 994 例男性。不同省份的患者 PM2.5 暴露水平不同，但总体而言，北方患者的 PM2.5 暴露水平高于南方患者。不同地区 PM2.5 暴露的严重程度与地区肾衰竭负担相关。此外，在研究开始前每年平均 PM2.5 暴露量每增加 10μg/m（风险比，1.14；95%置信区间，1.06-1.22）或研究开始后时间变化的 PM2.5 暴露量（1.10；1.01-1.18）与调整年龄、性别、估计肾小球滤过率、尿蛋白、尿酸、血红蛋白、平均动脉压、牛津分类、糖皮质激素和肾素-血管紧张素系统阻滞剂治疗后肾衰竭风险增加相关。在根据上述模型进一步调整心血管疾病的时间段、危险因素或城市规模后，这些关联仍然稳健。因此，我们的结果表明，PM2.5 是 IgAN 患者肾衰竭的一个独立危险因素，但这些发现需要在更多样化的人群和其他地理区域中进行验证。
