Shi Xiaolei, Tang Yaoyao, Xiang Wang, Yu Jianwen, Wang Xin, Ye Hongjian, Zhong Zhong, Wu Haishan, Tang Ruihan, Xia Xi, Chen Wei
Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, People's Republic of China.
NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, People's Republic of China.
Int J Med Sci. 2025 Apr 28;22(10):2398-2407. doi: 10.7150/ijms.106393. eCollection 2025.
Dyslipidemia is common in lupus nephritis (LN). However, the relationship between the total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio and LN remains unclear. This study was designed to investigate the association between the TC/HDL-C ratio and LN. This study included individuals diagnosed with LN between January 1, 1996 and December 31, 2018. Split by the optimal cutoff TC/HDL-C ratio value of the primary outcome, patients were divided into lower (<6.71) and higher (≥6.71) TC/HDL-C ratio groups. Multivariate Cox regression analysis and subgroup analyses were carried out to confirm the connection of the TC/HDL-C ratio with the adverse clinical outcomes in LN. A total of 818 patients with LN were followed up for a median of ten years and 129 (15.77%) experienced all-cause death and 119 (14.55%) reached adverse renal events. Kaplan-Meier survival analyses demonstrated that patients exhibited a higher TC/HDL-C ratio were more susceptible to all-cause death (P=0.003) and adverse renal outcomes (P=0.001) in LN. After adjustments, a higher TC/HDL-C ratio still exhibited significant correlations with all-cause death [hazard ratio (HR):1.51, 95% confidence interval (CI): 1.03-2.23; P=0.036] and adverse renal outcomes in LN patients [HR: 1.57, 95%CI: 1.05-2.36; P=0.028]. Further subgroup analyses revealed that LN patients who were male, younger than 40 years old or with estimated glomerular filtration rate under 60 ml/min/1.73m2 seemed to be more susceptible to adverse clinical outcomes (P<0.05). An elevated TC/HDL-C ratio exhibited significant associations with poor prognosis in LN. Patients with LN may benefit from further TC/HDL-C studies.
血脂异常在狼疮性肾炎（LN）中很常见。然而，总胆固醇/高密度脂蛋白胆固醇（TC/HDL-C）比值与LN之间的关系仍不清楚。本研究旨在调查TC/HDL-C比值与LN之间的关联。本研究纳入了1996年1月1日至2018年12月31日期间被诊断为LN的个体。根据主要结局的最佳截断TC/HDL-C比值，将患者分为TC/HDL-C比值较低（<6.71）和较高（≥6.71）两组。进行多变量Cox回归分析和亚组分析，以确认TC/HDL-C比值与LN不良临床结局之间的联系。共有818例LN患者接受了中位时间为10年的随访，129例（15.77%）发生全因死亡，119例（14.55%）出现不良肾脏事件。Kaplan-Meier生存分析表明，LN患者中TC/HDL-C比值较高者更易发生全因死亡（P=0.003）和不良肾脏结局（P=0.001）。调整后，较高的TC/HDL-C比值仍与LN患者的全因死亡[风险比（HR）：1.51，95%置信区间（CI）：1.03-2.23；P=0.036]和不良肾脏结局显著相关[HR：1.57，95%CI：1.05-2.36；P=0.028]。进一步的亚组分析显示，男性、年龄小于40岁或估计肾小球滤过率低于60 ml/min/1.73m2的LN患者似乎更易发生不良临床结局（P<0.05）。升高的TC/HDL-C比值与LN的不良预后显著相关。LN患者可能会从进一步的TC/HDL-C研究中获益。
