血清胱抑素C水平与IgA肾病临床及病理特征的相关性  

Correlation between serum cystatin C level and clinicopathological features of IgA nephropathy

作　　者：蔡小凡[1] 符欣漪 蔡秀峰 罗健华[1] 钟逸斐[1] 邓跃毅[1] Cai Xiaofan;Fu Xinyi;Cai Xiufeng;Luo Jianhua;Zhong Yifei;Deng Yueyi(Deptatment of Nephrology,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Shanghai 200032,China;Longhua Clinical Medical College Affiliated to Shanghai University of traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院肾病科,上海200032 [2]上海中药大学附属龙华临床医学院,上海200032

出　　处：《中华检验医学杂志》2022年第9期957-962,共6页Chinese Journal of Laboratory Medicine

基　　金：上海市进一步加快中医药事业发展三年行动计划(ZY3-CCCX-2-1002);国家自然科学基金(81573768);上海龙华医院爱建基金(AJ069);益肾化湿颗粒临床应用研究和基础研究开放项目。

摘　　要：目的探讨血清胱抑素C(CysC)与IgA肾病临床及病理特征的相关性。方法收集2010年1月至2021年1月在上海中医药大学附属龙华医院经肾活检确诊的原发性IgA肾病421例进行回顾性分析。根据肾活检时血清CysC水平分为血清CysC高水平组(≥1.03 mg/L)及CysC正常组,对患者的临床资料及病理指标进行比较,采用Spearman法分析估算的肾小球滤过率(eGFR)与血清CysC的相关性,多元线性回归分析与血清CysC水平相关的临床病理因素,并用受试者工作特征(ROC)曲线下面积(AUC)评估联合血清CysC预测相关病理损伤的能力。结果CysC高水平组患者的年龄、合并高血压、血肌酐、尿素及血尿酸水平均明显高于血清CysC正常组,而eGFR水平明显低于血清CysC正常组(P均<0.05)。Spearman相关性分析显示,血清CysC与eGFR呈负相关(r=-0.744,P<0.001)。在病理损伤方面,CysC高水平组在肾小管萎缩与肾间质纤维化及肾小动脉管壁增厚等程度高于CysC正常组(P均<0.05)。多元线性回归分析提示,高血压、血肌酐、尿素、血尿酸、肾小管萎缩与肾间质纤维化及肾小动脉管壁增厚与血清CysC水平具有相关性(标准回归系数β值分别为0.048、0.299、0.260、0.134、0.195、0.068,P均<0.05)。在临床因素的基础上加入血清CysC后,能提高对肾小管萎缩和肾间质纤维化的预测效能[AUC分别为0.829(95%CI 0.787~0.870)、0.847(95%CI 0.808~0.886),P<0.05]。结论原发性IgA肾病患者年龄偏大、合并高血压、肾功能水平较差、病理损伤程度较重时,更易出现血清Cys C水平升高。血清CysC与高血压、血肌酐、尿素、血尿酸、肾小管萎缩与肾间质纤维化及肾小动脉管壁增厚相关。联合血清CysC水平可有效提高对肾小管萎缩与肾间质纤维化的预测能力。Objective To investigate the correlation between serum cystatin C(CysC)and clinical and pathological features of IgA nephropathy.Methods Four hundred and twenty-one cases of primary IgA nephropathy diagnosed by renal biopsy in Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2010 to January 2021 were retrospectively analyzed.According to the serum CysC level at the time of renal biopsy,the patients were divided into high serum CysC group and normal serum CysC group,and the clinical data and pathological indices of the patients were compared.Spearman correlation analysis was used to analyze the correlation between estimated glomerular filtration rate(eGFR)and serum CysC.The clinicopathological factors related to the serum CysC level were analyzed by multiple linear regression.The area under the receiver operator characteristic curve(AUC)was used to evaluate the ability of serum CysC level to predict related pathological injury.Results The age,prevalence of hypertension,serum creatinine,urea and uric acid levels of high serum CysC group were significantly higher than those of normal serum CysC group,while the eGFR level was significantly lower than that of normal serum CysC group(P<0.05).Spearman correlation analysis showed that serum CysC was negatively correlated with eGFR(r=-0.744,P<0.001).In terms of pathological injury,the degree of renal tubular atrophy and renal interstitial fibrosis(T)and renal arteriole wall thickening(A)in high serum CysC group were more serious than those in normal serum CysC group(P<0.05).Multiple linear regression analysis showed that the prevalence of hypertension,serum creatinine,urea,uric acid,T and A were correlated with serum CysC levels(standard regression coefficientβ=0.048,0.299,0.260,0.134,0.195,0.068,respectively,P<0.05).After adding serum CysC on the basis of clinical features,the prediction efficiency of renal tubular atrophy and renal interstitial fibrosis was higher(AUC were 0.829[95%CI 0.787-0.870],0.847[95%CI 0.808-0.886],

关 键 词：肾小球肾炎 IGA肾病 半胱氨酸蛋白酶抑制剂 

分 类 号：R692.31[医药卫生—泌尿科学]