肾小球半乳糖缺陷型IgA1沉积可能与糖尿病肾病患者预后不良有关  

Glomerular galactose-deficient IgA1 positive may be associated with poor prognosis in diabetic nephropathy patients

作　　者：徐潇漪[1] 郭唯一 程虹[1] 孙丽君[1] 王国勤[1] 程文荣 董鸿瑞[1] Xu Xiaoyi;Guo Weiyi;Cheng Hong;Sun Lijun;Wang Guoqin;Cheng Wenrong;Dong Hongrui(Renal Division,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院肾内科

出　　处：《中华肾脏病杂志》2025年第1期22-30,共9页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81900653);首都卫生发展科研专项项目(2022-2-2066)。

摘　　要：目的探讨经肾活检诊断为糖尿病肾病(diabetic nephropathy,DN)伴IgA沉积患者的临床特征和预后。方法该研究为回顾性队列研究。回顾性收集2010年1月1日至2023年3月31日在首都医科大学附属北京安贞医院经肾活检诊断为DN患者的临床病理资料。按照患者肾组织是否伴IgA沉积分为DN-IgA沉积组和不伴IgA沉积的DN组,比较两组患者临床病理特征和预后的差异。免疫荧光染色法检测DN-IgA沉积组患者肾组织半乳糖缺陷型IgA1(galactose-deficient IgA1,Gd-IgA1)染色强度,并按照染色强度是否≥2+分亚组;酶联免疫吸附法检测患者血清Gd-IgA1水平。肾脏终点事件定义为5年内估算肾小球滤过率较基线值下降50%或进展至终末期肾病,Kaplan-Meier生存曲线和Log-rank检验分析肾组织IgA沉积和Gd-IgA1沉积对DN患者肾脏终点事件累积发生率的影响。结果共101例DN患者入选该研究,男性68例(67.3%),女性33例(32.7%),年龄(52.2±10.3)岁,中位随访时间13.5(4.8,26.3)个月,伴IgA沉积组44例(43.6%),不伴IgA沉积组57例(56.4%)。Kaplan-Meier生存分析结果显示,与不伴IgA沉积组相比,伴IgA沉积组患者5年内肾脏终点事件累积发生率较高(χ^(2)=6.473,P=0.011)。伴IgA沉积组患者肾小球Gd-IgA1(KM55)染色阳性的比例为54.5%(24/44),且免疫荧光检查示Gd-IgA1与IgA沉积区域在肾小球系膜和毛细血管区域的分布一致,其中肾小球Gd-IgA1阳性患者血清中Gd-IgA1水平显著高于肾小球Gd-IgA1阴性患者[(6296.4±1535.4)μg/L比(4057.4±1082.0)μg/L,t=-3.037,P=0.010]。与非终点事件亚组比较,虽然终点事件亚组患者的年龄较小[(42.8±6.9)岁比(53.3±9.4)岁,t=-3.440,P=0.002],蛋白尿病程较短[6.0(1.0,22.0)个月比12.0(10.0,36.0)个月,Z=-2.150,P=0.032],但肾小球Gd-IgA1染色强度≥2+的患者比例较高[Fisher精确概率检验,30.8%(4/13)比0(0/20),P=0.017]。Kaplan-Meier生存分析结果显示,与Gd-IgA1染色强度<2+亚组比较,肾小球Gd-IgA1染色强Objective To investigate the different clinical characteristics and prognosis of patients with diabetic nephropathy(DN)accompanied by IgA deposition diagnosed by renal biopsy.Methods The study was a retrospective cohort study.Clinical and pathological data of patients diagnosed with DN through renal biopsy in Beijing Anzhen Hospital affiliated to Capital Medical University from January 1,2010 to March 31,2023 were retrospectively collected.The clinical and pathological characteristics and prognosis of DN patients with IgA deposition and DN control group patients without IgA deposition were compared.Immunofluorescence staining was used to detect the intensity of galactose‐deficient IgA1(Gd‐IgA1)staining in renal tissue of DN patients with DN IgA deposition,and grouping was performed according to whether the staining intensity was≥2+.Enzyme linked immunosorbent assay was used to detect the serum level of Gd‐IgA1 in patients.A 50%decrease in estimated glomerular filtration rate(eGFR)from baseline or progression to end-stage renal disease within 5 years was defined as a renal endpoint event,and Kaplan‐Meier survival analysis and Log‐rank test were used to compare the difference in cumulative incidence of renal endpoint events between two groups of patients.Results A total of 101 DN patients were enrolled in this study,including 68 males(67.3%)and 33 females(32.7%),with age of(52.2±10.3)years and a median follow-up time of 13.5(4.8,26.3)months.There were 44 patients with IgA deposition(43.6%)and 57 patients without IgA deposition(56.4%).Compared with DN control group,Kaplan-Meier analysis showed that DN patients with IgA deposition had a higher cumulative incidence of renal endpoint within 5 years(χ^(2)=6.473,P=0.011).The proportion of positive glomerular Gd‐IgA1(KM55)staining in the DN patients with IgA deposition was 54.5%(24/44),and immunofluorescence examination showed consistent distribution of Gd‐IgA1 and IgA in the glomerular mesangial and capillary regions.The serum level of Gd‐IgA1 in the

关 键 词：糖尿病肾病 免疫球蛋白A 预后 IGA沉积 

分 类 号：R69[医药卫生—泌尿科学]