IgA肾病中血清甲状旁腺激素与肾间质纤维化关系的初步探讨  

A Study on the Relationship Between iPTH Level and Renal Interstitial Fibrosis in Patients with IgA Nephropathy

作　　者：黄威 徐静[1] 谢静远 王朝晖 潘晓霞 王伟铭[1] 陈楠[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏科,上海交通大学医学院肾脏病研究所,上海200025

出　　处：《中国中西医结合肾病杂志》2017年第3期217-221,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家自然科学基金资助项目(No.81270782;30771000);国家重点基础研究发展计划(973计划)项目(No.2012CB517701);科技部十二五科技攻关项目(No.2011BAI10B00);上海市卫计委重中之重学科建设项目;国家临床重点专科建设项目;卫生行业科研专项项目(No.201002010)

摘　　要：目的:从临床角度探讨IgA肾病患者中血清甲状旁腺激素(serum parathyroid hormone,PTH)与肾脏病理中肾间质纤维化(renal interstitial fibrosis,RIF)程度的关系,试图寻找一种无创手段评估肾间质纤维化程度的方法。方法:本研究纳入了原发性IgA肾病患者226例。记录患者的临床及肾活检病理资料,按肾间质纤维化的严重程度依次分为1级(无或轻度)、2级(中度)和3级(重度);比较不同程度的肾间质纤维化患者的血iPTH和肾功能指标差异,分析间质纤维化程度和血iPTH的相关性,利用多元线性回归模型寻找肾间质纤维化的影响因素以及RIF的预测公式。结果:采用单因素方差分析法(ANOVA)进行分析,结果提示不同的肾间质纤维化程度的IgA肾病患者的血iPTH水平差异具有统计学意义(P=5.38×10^(-7))。每个肾间质纤维化等级分组两两之间的eGFR差异均有统计学意义(P值均<0.01)。对肾间质纤维化等级与血iPTH之间行Spearman相关分析,提示两者具有一定相关性(P=10^(-6),R=0.35)。线性回归模型提示发病年龄、血iPTH、eGFR可在一定程度上反映肾间质纤维化的严重程度。结论:IgA肾病患者中,不同肾间质纤维化程度的患者血iPTH水平亦有显著不同,随着肾间质纤维化程度的加重,血iPTH水平逐渐升高,且两者具有一定相关性;IgA肾病患者的发病年龄、血iPTH、eGFR水平与肾间质纤维化的病变程度密切相关。Objective：To investigate the relationship between serum parathyroid hormone （PTH） and renal interstitial fibro- sis（ RIF）, and to find a noninvasive method to predict renal interstitial fibrosis levels in IgAN patients. Methods：Clinical and patho- logical data were collected and retrospectively analyzed in 226 primary IgAN patients. Patients were divided into three groups accord- ing to the RIF severity： Grade 1 （ no or mild lesions, G1 ）, Grade 2 （ moderate lesions, G2） and Grade 3 （ severe lesions, G3 ）, which was based on Katafuchi criteria and Oxford classification. Serum iPTH levels as well as biochemical parameters were compared respectively among the different RIF groups. The correlation between RIF grades and iPTH was analyzed. Prediction model of RIF was proposed by multiple linear regression. Results：Serum iPTH in different RIF groups is of significant difference by ANOVA （P = 5.38 × 10 ^-7 ）. Paired comparison of ANOVA among GI, G2 and G3 demonstrated significant difference in serum creatinine, uric acid and eGFR （ all the P values less than 0.01 ）. Spearman analysis showed positive correlation between RIF grades and serum iPTH lev- els （P = 10^ -6, R = 0.35）. Age of onset, iPTH and eGFR were listed in the final linear regression model to predict RIF grades. Con- dusion：Serum iPTH levels are significantly higher in patients with more severe RIF lesions in IgA nephropathy. There is a strong pos- itive correlation between RIF grades and serum iPTH levels. Age of onset, iPTH and eGFR may be able to predict RIF levels in a non - invasive way.

关 键 词：IGA肾病 血甲状旁腺激素 肾间质纤维化 多元线性回归 

分 类 号：R692.31[医药卫生—泌尿科学]