Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China,
Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Kidney Blood Press Res. 2023;48(1):186-193. doi: 10.1159/000529822. Epub 2023 Apr 14.
Immunoglobulin A nephropathy (IgAN) is one of the most common glomerulonephritic diseases in the world. Several lines of evidence have suggested that dyslipidemia is related to the disease progression and prognosis of IgAN. However, the study is scarce on the clinicopathological characteristics and outcomes of IgAN with dyslipidemia.
This study retrospectively analyzed 234 patients with biopsy-proven idiopathic IgAN at the Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, between January 2015 and June 2021. The participants were divided into dyslipidemia (n = 119) and non-dyslipidemia (n = 115), and the dyslipidemia group was also divided into the following 4 groups: hypertriglyceridemia group, hypercholesterolemia group, mixed hyperlipidemia group, and low high-density lipoprotein cholesterol group. The estimated glomerular filtration rate (eGFR) was estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
The prevalence of dyslipidemia in IgAN patients in our center was 50.9% (119/234). The patients with dyslipidemia presented with higher systolic blood pressure (BP), diastolic BP, serum creatinine, uric acid, hemoglobin, proteinuria, and eGFR (p < 0.05). Proportions of males, hypertension, and chronic kidney disease stage 2∼5 were also higher in the dyslipidemia group (p < 0.05). Similarly, the pathological characteristics performed were worse in the dyslipidemia group. Most dyslipidemia patients had a higher percentage of mesangial hypercellularity (M1) and tubular atrophy/interstitial fibrosis (T1∼2) in the Oxford Classification's scoring system (p < 0.05). Multivariate logistic regression analysis revealed that male gender (odds ratio [OR] = 2.397, 95% confidence interval [CI]: 1.051-5.469, p = 0.038) and proteinuria (OR = 1.000, 95% CI: 1.000-1.001, p = 0.035) were possible risk factors for dyslipidemia. A total of 13 patients (13.8%) in the dyslipidemia group had an endpoint event, of which 6 patients (6.4%) had a ≥50% decrease in eGFR from baseline and 7 patients (7.4%) reached the end-stage renal disease stage. Kaplan-Meier survival curve analysis showed that patients in the dyslipidemia group had a worse outcome than those in the non-dyslipidemia group (log-rank test, p = 0.048).
IgAN patients with dyslipidemia presented more severe clinicopathological characteristics. Male gender and proteinuria are significantly associated with the occurrence of dyslipidemia in IgAN patients. Patients in the dyslipidemia group had a worse prognosis than those in the non-dyslipidemia group, which may be essential for the disease management of IgAN and help identify the high-risk patients.
免疫球蛋白 A 肾病（IgAN）是世界上最常见的肾小球肾炎之一。有几条证据表明，血脂异常与 IgAN 的疾病进展和预后有关。然而，关于伴有血脂异常的 IgAN 的临床病理特征和结局的研究还很少。
本研究回顾性分析了 2015 年 1 月至 2021 年 6 月在上海中医药大学附属龙华医院肾病科接受肾活检证实的特发性 IgAN 患者 234 例。患者分为血脂异常组（n=119）和非血脂异常组（n=115），血脂异常组又分为高甘油三酯血症组、高胆固醇血症组、混合性高脂血症组和低高密度脂蛋白胆固醇血症组。采用慢性肾脏病流行病学合作（CKD-EPI）方程估算肾小球滤过率（eGFR）。
本中心 IgAN 患者血脂异常的患病率为 50.9%（119/234）。血脂异常组患者的收缩压、舒张压、血肌酐、尿酸、血红蛋白、蛋白尿和 eGFR 均较高（p＜0.05）。血脂异常组男性、高血压和慢性肾脏病 2∼5 期的比例也较高（p＜0.05）。同样，血脂异常组的病理特征也较差。在牛津分类评分系统中，大多数血脂异常患者的系膜细胞增生（M1）和肾小管萎缩/间质纤维化（T1∼2）比例较高（p＜0.05）。多因素 logistic 回归分析显示，男性（比值比[OR]=2.397，95%置信区间[CI]：1.051-5.469，p=0.038）和蛋白尿（OR=1.000，95%CI：1.000-1.001，p=0.035）是血脂异常的可能危险因素。血脂异常组共有 13 例（13.8%）患者出现终点事件，其中 6 例（6.4%）患者 eGFR 较基线下降≥50%，7 例（7.4%）患者达到终末期肾病阶段。Kaplan-Meier 生存曲线分析显示，血脂异常组患者的预后较非血脂异常组患者差（对数秩检验，p=0.048）。
伴有血脂异常的 IgAN 患者表现出更严重的临床病理特征。男性和蛋白尿与 IgAN 患者血脂异常的发生显著相关。血脂异常组患者的预后较非血脂异常组患者差，这可能对 IgAN 的疾病管理具有重要意义，并有助于识别高危患者。
