25羟维生素D3、M型磷脂酶A2受体基因多态性交互影响原发性膜性肾病病情进展的研究  

Interactive effect of 25-hydroxyvitamin D3 and M-type phospholipase A2 receptor gene polymorphism on the progression of idiopathic membranous nephropathy

作　　者：黄显莉 文飞亚 郝炎[1] Huang Xian-li;Wen Fei-ya;Hao Yan(Department of Nephrology,The First People's Hospital of Zigong,Zigong 643000,China;Department of Vascular Surgery,The First People's Hospital of Zigong,Zigong 643000,China)

机构地区：[1]自贡市第一人民医院肾内科,自贡643000 [2]自贡市第一人民医院血管外科,自贡643000

出　　处：《临床肾脏病杂志》2024年第10期834-840,共7页Journal Of Clinical Nephrology

基　　金：2021年自贡市医学科学院医疗卫生自有资金引导项目(2021ZCYKY06)。

摘　　要：目的探究25羟维生素D3[1,25-dihydroxy vitmin D3,25-(OH)D3]、M型磷脂酶A2受体(M-type phospholipase A2 receptor 1,PLA2R1)基因多态性交互影响原发性膜性肾病(idiopathic membranous nephropathy,IMN)病情进展的作用。方法选取2019年1月至2023年1月自贡市第一人民医院收治的101例IMN患者进行前瞻性研究,根据6个月内是否复发分为复发组、未复发组。比较两组患者基线资料、25-(OH)D3水平、PLA2R1基因多态性,以Logistic回归分析影响IMN病情进展的因素,以交互作用系数γ和OR值分析25-(OH)D3、PLA2R1基因多态性交互影响IMN病情进展的作用。结果复发组尿酸[(419.36±25.44)μmol/L比(366.20±28.34)μmol/L]高于未复发组,25-(OH)D3水平[(33.60±10.74)nmol/L比(42.40±9.56)nmol/L]低于未复发组(P<0.05)。复发组rs4664308位点AA基因型(69.44%比44.62%)患者占比高于未复发组,GA基因型(27.78%比43.08%)、GG基因型(2.78%比12.31%)患者占比低于未复发组(P<0.05)。Logis-tic回归分析显示,尿酸、25-(OH)D3、rs4664308位点GA和AA基因型均与IMN病情进展相关(P<0.05),尿酸每升高一个单位,IMN患者病情进展的风险增加4.233倍;25-(OH)D3每降低一个单位,IMN患者病情进展的风险增加0.581倍;rs4664308位点GA和AA基因型患者,病情进展的风险分别是基因型GG患者的3.253、4.054倍。交互作用分析显示,25-(OH)D3和PLA2R1基因多态性交互的OR值<两者单独存在OR值的乘积,两者对IMN病情进展的影响符合次相乘模型,且交互作用系数γ>1,25-(OH)D3非正常对PLA2R1基因多态性的效应具有正向交互作用(P<0.05)。结论25-(OH)D3、PLA2R1基因多态性均与IMN患者病情进展有关,25-(OH)D3水平对PLA2R1基因多态性的效应具有正向交互作用,联合检测两者状态可能有助于预测患者病情进展的风险,为临床个性化预防干预提供决策支持。Objective To explore the interaction between 1,25-hydroxyvitamin D3[25-(OH)D3]and M-type phospholipase A2 receptor 1(PLA2R1)gene polymorphism in the progression of idiopathic membranous nephropathy(IMN).Methods A total of 101 hospitalized IMN patients from January 2019 to January 2023 were selected for this prospective study.They were assigned into two groups of recurrence and non-recurrence according to whether or not relapse occured within 6 months.Baseline profiles,25-(OH)D3 level and PLA2R1 gene polymorphism were compared between two groups.Logistic regression was utilized for examining the influencing factors of IMN progression.And interaction coefficientγand OR values were employed for analyzing the interaction effects of 25-(OH)D3 and PLA2R1 gene polymorphism on IMN progression.Results The level of uric acid was higher in recurrence group than that in non-recurrence group[(419.36±25.44)μmol/L vs(366.20±28.34)μmol/L]while 25-(OH)D3 level was lower than that in non-recurrence group[(33.60±10.74)nmol/L vs(42.40±9.56)nmol/L,P<0.05].The proportion of patients with AA genotype at rs4664308 locus was higher in recurrence group than that in non-recurrence group(69.44%vs 44.62%)while the proportions of patients with GA genotype(27.78%vs 43.08%)and GG genotype(2.78%vs 12.31%)were lower than those in non-recurrent group(P<0.05).Logistic regression analysis revealed that uric acid,25-(OH)D3,GA and AA genotypes at rs4664308 were correlated with the progression of IMN(P<0.05);the risk of progression spiked by 4.233 folds for each unit of uric acid increase.For each unit reduction of 25-(OH)D3,the risk of disease progression increased by 0.581 fold.The risk of disease progression in GA and AA genotype rs4664308 patients was 3.253 and 4.054 folds higher than that in GG genotype ones.Interaction analysis showed that OR values of interaction between 25-(OH)D3 and PLA2R1 gene polymorphisms were<product of OR values of two genes alone and the effects of two genes on the progression of IMN were in line with sub-multipli

关 键 词：25羟维生素D3 M型磷脂酶A2受体 基因多态性 交互作用 原发性膜性肾病 

分 类 号：R692[医药卫生—泌尿科学]