Ju Tao, Peng Yingchao, Wei Yaqin, Li Xiaojie, Wang Meiqiu, Wang Ren, Yang Xiao, Zhang Zhiqiang, Gao Chunlin, Xia Zhengkun
Department of Pediatrics, Jinling Hospital, Nanjing Medical University, Nanjing, China.
Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Front Pediatr. 2023 Feb 6;11:1072969. doi: 10.3389/fped.2023.1072969. eCollection 2023.
Minimal change disease (MCD) is the most common pathological subtype of pediatric idiopathic nephrotic syndrome (INS). It has been suggested that IgM deposition might predict kidney function deterioration in the course of MCD. However, the specific role of IgM deposition in the prognosis of MCD is still controversial. This study aims to investigate the clinical significance of IgM deposition on delayed remission and early relapse in a pediatric population.
This study enrolled 283 children diagnosed with MCD by renal biopsy in a single center from 2010 to 2022. These cases were divided into two groups according to the histopathological deposition of IgM. Patients' demographics, clinical parameters, and follow-up data were collected and analyzed. The primary and secondary outcomes were defined as the time to the first remission and the first relapse.
The IgM-positive group had a weaker response to steroids (steroid-sensitive: 23.5% vs. 40.8%; steroid-dependent: 74.0% vs. 51.0%; steroid-resistant: 18.4% vs. 8.2%, = 0.001), and showed more recurrent cases (47.2% vs. 34.4%, = 0.047) compared with the IgM-negative group. The Kaplan-Meier analysis showed that the IgM-positive group had a lower cumulative rate of the first remission (Log-rank, < 0.001) and a higher rate of the first relapse (Log-rank, = 0.034) than the IgM-negative group. Multivariate Cox analysis showed that IgM deposition was independently associated with the delayed first remission (hazard ratio [HR] = 0.604, 95% confidence interval [CI] = 0.465-0.785, < 0.001) and the early first relapse (HR = 1.593, 95% CI = 1.033-2.456, = 0.035).
IgM deposition was associated with a weaker steroid response. MCD children with IgM deposition were prone to delayed first remission and early first relapse.
微小病变病（MCD）是儿童特发性肾病综合征（INS）最常见的病理亚型。有研究表明，免疫球蛋白M（IgM）沉积可能预示MCD病程中肾功能恶化。然而，IgM沉积在MCD预后中的具体作用仍存在争议。本研究旨在探讨IgM沉积对儿童延迟缓解和早期复发的临床意义。
本研究纳入了2010年至2022年在单中心经肾活检确诊为MCD的283例儿童。根据IgM的组织病理学沉积情况将这些病例分为两组。收集并分析患者的人口统计学资料、临床参数和随访数据。主要和次要结局分别定义为首次缓解时间和首次复发时间。
与IgM阴性组相比，IgM阳性组对类固醇的反应较弱（类固醇敏感：23.5%对40.8%；类固醇依赖：74.0%对51.0%；类固醇抵抗：18.4%对8.2%，P = 0.001），且复发病例更多（47.2%对34.4%，P = 0.047）。Kaplan-Meier分析显示，IgM阳性组首次缓解的累积率低于IgM阴性组（对数秩检验，P < 0.001），首次复发率高于IgM阴性组（对数秩检验，P = 0.034）。多因素Cox分析显示，IgM沉积与首次缓解延迟独立相关（风险比[HR] = 0.604，95%置信区间[CI] = 0.465 - 0.785，P < 0.001）以及首次复发早期独立相关（HR = 1.593，95% CI = 1.033 - 2.456，P = 0.035）。
IgM沉积与类固醇反应较弱有关。IgM沉积的MCD患儿容易出现首次缓解延迟和首次复发早期。
