高血清胱抑素C是IgA肾病肾脏预后不良的独立危险因素。
[High serum cystatin C is an independent risk factor for poor renal prognosis in IgA nephropathy].
作者信息
Tang Tianwei, Li Luan, Chen Yuanhan, Zhang Li, Xu Lixia, Li Zhilian, Feng Zhonglin, Zhang Huilin, Hua Ruifang, Ye Zhiming, Liang Xinling, Li Ruizhao
机构信息
Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2025 Feb 20;45(2):379-386. doi: 10.12122/j.issn.1673-4254.2025.02.19.
OBJECTIVES
To explore the value of serum cystatin C (CysC) levels in evaluating renal prognosis in IgA nephropathy (IgAN) patients.
METHODS
We retrospectively collected the clinical data of IgAN patients diagnosed by renal biopsy at Guangdong Provincial People's Hospital from January, 2014 to December, 2018. Based on baseline serum CysC levels, the patients were divided into high serum CysC (>1.03 mg/L) group and normal serum CysC (≤1.03 mg/L) group. The composite endpoint for poor renal prognosis was defined as ≥50% decline in estimated glomerular filtration rate (eGFR) and/or progression to end-stage renal disease (ESRD). Lasso regression, multivariate Cox regression and Kaplan-Meier survival analysis were used to identify the risk factors and compare renal survival rates between the two groups. Smooth curves fitting and threshold effect analysis were used to explore the relationship between serum CysC levels and the outcomes. A nomogram model was constructed and its predictive performance was evaluated using concordance index, calibration curve, receiver operating characteristic (ROC) curve and the area under curve (AUC).
RESULTS
A total of 356 IgAN patients were enrolled, who were followed up for 4.65±0.93 years. The composite endpoint occurred in 74 patients. High serum CysC was identified as an independent risk factor for poor renal prognosis in IgAN (=2.142, 95% 1.222 to 3.755), and the patients with high serum CysC levels had a lower renal survival rate (Log-rank χ=47.970, <0.001). In patients with serum CysC below 2.12 mg/L, a higher CysC level was associated with an increased risk of poor renal prognosis (=3.487, 95% : 2.561-4.413, <0.001), while above this level, the increase of the risk was not significant (=0.676, 95% : -0.642-1.995, =0.315). The nomogram model based on serum CysC and 3 other independent risk factors demonstrated good internal validity with a concordance index of 0.873 (95% : 0.839-0.907) and an AUC of 0.909 (95% : 0.873-0.945).
CONCLUSIONS
Serum CysC levels are associated with renal prognosis in IgAN patients, and high serum CysC an independent risk factor for poor renal prognosis.
目的
探讨血清胱抑素C（CysC）水平在评估IgA肾病（IgAN）患者肾脏预后中的价值。
方法
回顾性收集2014年1月至2018年12月在广东省人民医院经肾活检确诊的IgAN患者的临床资料。根据基线血清CysC水平，将患者分为高血清CysC（>1.03mg/L）组和正常血清CysC（≤1.03mg/L）组。肾脏预后不良的复合终点定义为估计肾小球滤过率（eGFR）下降≥50%和/或进展至终末期肾病（ESRD）。采用Lasso回归、多因素Cox回归和Kaplan-Meier生存分析来识别危险因素并比较两组的肾脏生存率。采用平滑曲线拟合和阈值效应分析来探讨血清CysC水平与结局之间的关系。构建列线图模型，并使用一致性指数、校准曲线、受试者操作特征（ROC）曲线和曲线下面积（AUC）评估其预测性能。
结果
共纳入356例IgAN患者，随访4.65±0.93年。74例患者出现复合终点。高血清CysC被确定为IgAN患者肾脏预后不良的独立危险因素（=2.142，95% 1.222至3.755），高血清CysC水平的患者肾脏生存率较低（Log-rank χ=47.970，<0.001）。在血清CysC低于2.12mg/L的患者中，较高的CysC水平与肾脏预后不良风险增加相关（=3.487，95%：2.561 - 4.413，<0.001），而高于此水平，风险增加不显著（=0.676，95%： - 0.642 - 1.995，=0.315）。基于血清CysC和其他3个独立危险因素的列线图模型显示出良好的内部效度，一致性指数为0.873（95%：0.839 - 0.907），AUC为0.909（95%：0.873 - 0.945）。
结论
血清CysC水平与IgAN患者的肾脏预后相关，高血清CysC是肾脏预后不良的独立危险因素。
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