IgAN患者血CCL27与肾损害程度及病理分型的相关性研究  

The relationship between blood CCL27,clinical indicators and pathological changes of renal damage in IgAN patients

作　　者：何荟 甘露 孟瑚 周艳 沈颖[2] 徐争艳 饶金金 He Hui;Gan Lu;Meng Hu;Zhou Yan;Shen Ying;Xu Zhengyan;Rao Jinjin(Department of Nephrology,the First Affiliated Hospital of Xi′an Medical University,Xi′an,710077,China;Department of Nephrology,the First People′s Hospital of Yunnan Province Affiliated to Kunming University of Science and Technology Kunming 650034,China;Department of Nephrology,the First People′s Hospital of Xichou County,Wenshan Zhuang and Miao Autonomous Prefecture 663500,China;Department of Nephrology,Pu′er People′s Hospital,Pu′er 665000,China)

机构地区：[1]西安医学院第一附属医院肾脏内科,西安710077 [2]昆明理工大学附属云南省第一人民医院肾脏内科,昆明650034 [3]西畴县第一人民医院肾脏内科,文山壮族苗族自治州663500 [4]普洱市人民医院肾脏内科,普洱665000

出　　处：《国际泌尿系统杂志》2024年第4期682-688,共7页International Journal of Urology and Nephrology

基　　金：昆明理工大学医学联合专项项目(KUST-PE2022013Y);云南省科技厅基础研究计划项目(202001AU070038)。

摘　　要：目的探究外周血CCL27与IgA肾病(IgAN)患者的肾损害程度及病理分型的相关性,寻找便捷可靠的临床指标辅助诊断IgAN并评估病情进展。方法选取2021年2月至2022年8月在云南省第一人民医院经肾穿刺活检确诊为IgAN的122例患者作为IgAN组,选取该院体检中心39例健康体检者为对照组。测定患者的血浆CCL27水平并绘制受试者工作特征(ROC)曲线。根据血浆CCL27水平中位数1936.59 ng/mL将研究对象分为高水平CCL27组(61例)和低水平CCL27组(61例)。根据IgAN患者的不同临床表现,将其分为血尿组(76例)与无血尿组(46例),明显蛋白尿组(63例)与轻微蛋白尿组(59例),估算肾小球滤过率(eGFR)正常组(64例)与eGFR下降组(58例),高血压组(66例)与血压正常组(56例);分别比较不同临床表现分组患者的血浆CCL27水平。根据Lee氏分级,将IgAN患者分为Ⅰ~Ⅲ级组(80例)与Ⅳ~Ⅴ级组(42例),比较两组患者的血浆CCL27水平情况。再根据MEST-C分型的T分级,将IgAN患者分为T_(0)(32例)、T_(1)(67例)、T_(2)(23例)三组,比较三组患者的血浆CCL27水平情况;比较不同CCL27水平分组IgAN患者的牛津分型(MEST-C)评分情况。分析CCL27水平和IgAN患者的Lee氏分级和MEST-C评分的关系;并探讨CCL27水平与血肌酐(Scr)、尿蛋白、高血压、eGFR、血脂等指标的相关性。结果IgAN组的血浆CCL27水平高于对照组,差异有统计学意义(P<0.001)。血浆CCL27水平对IgAN诊断的ROC曲线分析结果显示,CCL27的曲线下面积为0.755(95%CI:0.668~0.843),特异度为91.8%(P<0.001)。高水平CCL27组患者的血尿素氮(BUN)、Scr、血尿酸(UA)、24 h尿蛋白定量(24 h-UP)、尿蛋白肌酐比值(ACR)、高血压病发生率明显高于低水平CCL27组,胱抑素C低于低水平CCL27组(均P<0.05)。与轻微蛋白尿组相比,明显蛋白尿组IgAN患者的CCL27水平明显升高(P<0.05)。与eGFR正常组比较,eGFR下降组IgAN患者的CCL27水平升高(P<0.001)。与血压正常组比较,高�Objective To investigate the correlation between peripheral blood CCL27 and the degree of renal damage and pathologic staging of IgA nephropathy(IgAN),and to find a convenient and reliable clinical indicator to assist in the diagnosis of IgAN and assessment of disease progression.Methods The clinical data of 122 patients diagnosed as IgAN by renal puncture biopsy in the First People′s Hospital of Yunnan Province from February 2021 to August 2022 were selected as the study subjects as the IgAN group,and 39 healthy subjects from physical examination center of hospital were selected as the experimental control group.Plasma CCL27 levels were measured and ROC curves were plotted.According to the median plasma CCL27 level of 1936.59 ng/mL,the study subjects were divided into the high-level CCL27 group(61 cases)and the low-level CCL27 group(61 cases).According to the different clinical manifestations of IgAN patients,they were divided into hematuria group(76 cases)and no hematuria group(46 cases),obvious proteinuria group(63 cases)and slight proteinuria group(59 cases),estimated glomerular filtration rate(eGFR)normal group(64 cases)and eGFR decreased group(58 cases),hypertension group(66 cases)and normal blood pressure group(56 cases).The plasma CCL27 levels of patients in the subgroups were compared.According to Lee classification,patients with high and low levels of CCL27 were categorized intoⅠ-Ⅲgroup(80 cases)and LeeⅣ-Ⅴgroup(42 cases),and the Lee classification lesions of IgAN patients with different levels of CCL27 were compared.Then,according to the T classification of MEST-C classification,IgAN group was divided into three groups:T_(0)(32 cases),T_(1)(67 cases)and T_(2)(23 cases),and the plasma CCL27 level of the three groups was compared.To compare the MEST-C classification of IgAN patients with different levels of CCL27.The relationship between CCL27 level and Lee's grade and MEST-C pathological classification of IgAN patients was analyzed.The correlation between CCL27 and serum creatinine(Scr),urinary

关 键 词：肾小球肾炎 IGA CCL27 病理改变 

分 类 号：R692[医药卫生—泌尿科学]