IgA肾病患者血清C3与肾功能进展的相关性分析  

Association between serum C3 and progression of renal function in IgA nephropathy

作　　者：曹陶 许日聪 徐艺[1] 万启军[1] Cao Tao;Xu Ricong;Xu Yi;Wan Qijun(Department of Nephrology,the First Affiliated Hospital of Shenzhen University(the Second People's Hospital of Shenzhen),Shenzhen 518000,China)

机构地区：[1]深圳大学第一附属医院(深圳市第二人民医院)肾内科,深圳518000

出　　处：《中华肾脏病杂志》2021年第12期974-979,共6页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81900639);深圳市科创委基金(JCYJ20190806162807125);深圳市第二人民医院临床研究项目资助(20193357002);深圳市医学重点学科建设经费资助(SZXK009)。

摘　　要：目的探讨IgA肾病血清C3水平与肾功能进展的关系。方法本研究为单中心回顾性队列研究,选取2011年1月至2020年6月在深圳市第二人民医院住院、经肾活检证实为IgA肾病并随访至2021年1月的患者。排除继发性IgA肾病、基线估算肾小球滤过率(eGFR)<30 ml·min^(-1)·(1.73 m^(2))^(-1)、基线血清C3或血肌酐缺乏和随访时间<6个月的患者。收集患者的临床、实验室检查、肾脏病理等资料。采用阈值效应分析获取转折点,并采用计算机模拟重采样技术(bootstrapping resampling technique)计算拐点及95%可信区间。根据转折点将患者分为血清C3<0.97 g/L组和C3≥0.97 g/L组,比较两组之间的基线资料。采用Cox回归模型分析血清C3水平与肾功能进展的关系。结果共纳入414例患者,男性145例(35.0%);年龄(35.15±9.18)岁。基线eGFR为77.80(46.67,106.10)ml·min^(-1)·(1.73 m^(2))^(-1),血清C3为(1.04±0.19)g/L。患者血清C3<0.97 g/L组153例,血清C3≥0.97 g/L组261例。与血清C3≥0.97 g/L组相比,C3<0.97 g/L组患者年龄较小,女性比例较多,基线的血红蛋白和eGFR水平均较高,平均动脉压、总胆固醇、三酰甘油、血尿酸、血肌酐、24 h尿蛋白量、IgA和C4水平均较低(均P<0.05)。平滑曲线拟合发现血清C3与肾功能进展呈现“U”形曲线关系。阈值效应及多因素Cox回归分析结果显示,在校正了年龄、性别、平均动脉压、血尿酸、24 h尿蛋白量和肾脏病理指标(MESTC)等混杂因素后,当血清C3<0.97 g/L时,C3每增加0.1 g/L,肾功能进展风险下降40%(HR=0.60,95%CI 0.39~0.94,P=0.024);当血清C3≥0.97 g/L时,C3每增加0.1 g/L,肾功能进展风险增加27%(HR=1.27,95%CI 1.03~1.57,P=0.027);拐点为0.97(95%CI 0.92~1.01)g/L。结论IgA肾病患者血清C3与肾功能进展呈现曲线相关,血清C3水平维持在0.92~1.01 g/L与患者较好的肾脏预后相关。Objective To investigate the relationship between serum C3 and progression of renal function in IgA nephropathy.Methods A single-center retrospective cohort study was conducted in patients with IgA nephropathy confirmed by renal biopsy who were admitted to the Second People's Hospital of Shenzhen from January 2011 to June 2020 and the patients were followed up until January 2021.Patients with secondary IgA nephropathy,baseline estimated glomerular filtration rate(eGFR)<30 ml·min^(-1)·(1.73 m^(2))^(-1),lack of baseline serum C3 or creatinine,and follow-up time<6 months were excluded.The clinical data,laboratory examination and renal pathology were collected.The threshold effect analysis was used to obtain the cut-off point,and inflection point and 95%confidence interval were obtained using bootstrapping resampling technique.According to the cut-off point,the patients were divided into serum C3<0.97 g/L group and C3≥0.97 g/L group.The baseline data between the two groups were compared.Cox regression model was used to analyze the correlation between serum C3 level and renal function progression.Results A total of 414 patients were enrolled in this study,with 145 males(35.0%),and age of(35.15±9.18)years old.The baseline eGFR was 77.80(46.67,106.10)ml·min^(-1)·(1.73 m^(2))^(-1),and the serum C3 was(1.04±0.19)g/L.There were 153 patients with serum C3<0.97 g/L and 261 patients with serum C3≥0.97 g/L.Compared to patients with serum C3≥0.97 g/L,those patients with serum C3<0.97 g/L were younger and had higher proportion of females,higher levels of hemoglobin and eGFR,and lower levels of mean arterial pressure,total cholesterol,triglyceride,serum uric acid,serum creatinine,24 h urinary protein,IgA and C4(all P<0.05).The relationship between serum C3 and progression of renal function was found to be U-shaped by smooth curve fitting.After adjustment for confounding factors such as age,sex,mean arterial pressure,serum uric acid,24 h urinary protein,and renal pathology(MESTC),the results of the threshold effect and

关 键 词：肾小球肾炎 IgA 补体C3 肾功能不全 肾功能进展 平滑曲线拟合 

分 类 号：R692.31[医药卫生—泌尿科学]