Chen Lei, Chen Xizhao, Cai Guangyan, Jiang Hongli, Chen Xiangmei, Zhang Min
Department of Critical Care Nephrology and Blood Purification the First Affiliated Hospital of Xi'an Jiaotong University Xi'an Shaanxi China.
Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases Beijing Key Laboratory of Kidney Disease Research Beijing China.
MedComm (2020). 2024 Nov 3;5(11):e783. doi: 10.1002/mco2.783. eCollection 2024 Nov.
IgA nephropathy (IgAN) is the most prevalent primary glomerulonephritis, resulting in end-stage renal disease and increased mortality rates. Prognostic biomarkers reflecting molecular mechanisms for effective IgAN management are urgently needed. Analysis of kidney single-cell transcriptomic sequencing data demonstrated that IgAN expressed high-expression levels of inflammatory cytokines TNFSF10, TNFSF12, CCL2, CXCL1, and CXCL12 than healthy controls (HCs). We also measured the urine proteins in 120 IgAN (57 stable and 63 progressive) and 32 HCs using the proximity extension assay (PEA), and the multivariable and least absolute shrinkage and selection operator (LASSO) logistic regression analysis both revealed that CXCL12, MCP1 were the prognostic significant variables to predict IgAN progression severity. These two proteins exhibited negative correlation with the estimated glomerular filtration rate (eGFR) and patients with higher expression levels of these two proteins had a higher probability to have poorer renal outcome. We further developed a risk index model utilizing CXCL12, MCP1, and baseline clinical indicators, which achieved an impressive area under the curve (AUC) of 0.896 for prediction of IgAN progression severity. Our study highlights the significance of the inflammatory protein biomarkers for noninvasive prediction of IgAN severity and progression, offering valuable insights for clinical management.
IgA肾病(IgAN)是最常见的原发性肾小球肾炎,可导致终末期肾病并增加死亡率。迫切需要能反映有效管理IgA肾病分子机制的预后生物标志物。对肾脏单细胞转录组测序数据的分析表明,与健康对照(HCs)相比,IgA肾病中炎性细胞因子TNFSF10、TNFSF12、CCL2、CXCL1和CXCL12表达水平较高。我们还使用邻位延伸分析(PEA)检测了120例IgA肾病患者(57例病情稳定和63例病情进展)及32例健康对照者的尿蛋白,多变量及最小绝对收缩和选择算子(LASSO)逻辑回归分析均显示,CXCL12、MCP1是预测IgA肾病进展严重程度的预后显著变量。这两种蛋白与估计的肾小球滤过率(eGFR)呈负相关,这两种蛋白表达水平较高的患者肾脏预后较差的可能性更高。我们进一步利用CXCL12、MCP1和基线临床指标建立了一个风险指数模型,该模型预测IgA肾病进展严重程度的曲线下面积(AUC)达到了令人印象深刻的0.896。我们的研究突出了炎性蛋白生物标志物对IgA肾病严重程度和进展进行无创预测的重要性,为临床管理提供了有价值的见解。