中国全科医学 ›› 2023, Vol. 26 ›› Issue (29): 3657-3664.DOI: 10.12114/j.issn.1007-9572.2023.0013

• 论著 • 上一篇    下一篇

血小板/白蛋白比值与免疫球蛋白A肾病临床和病理特征的相关性研究

周文京1, 赏石丽2, 杨倩1, 冯悦荣1, 李俊1,*()   

  1. 1.650000 云南省昆明市,昆明医科大学第一附属医院肾内科
    2.655000 云南省曲靖市第二人民医院肾内科
  • 收稿日期:2022-12-20 修回日期:2023-02-19 出版日期:2023-10-15 发布日期:2023-03-28
  • 通讯作者: 李俊

  • 作者贡献:周文京负责研究设计及文章构思,并撰写文章初稿;赏石丽进行数据收集;杨倩进行数据整理;周文京、冯悦荣对数据进行统计学处理,并对结果进行分析与解释;李俊进行论文修订,负责文章的质量控制及审校,对文章整体负责,监督管理。
  • 基金资助:
    云南省教育厅科学研究基金项目(2022J0269); 云南省高层次人才"名医"专项(RLMY20200022); 昆明医科大学研究生创新基金(2022S221); 国家级教学质量工程项目(2022JXD209); 教育部国家级教学质量工程项目(202010678065)

Correlation of Platelet-albumin Ratio with Clinicopathological Features of IgA Nephropathy

ZHOU Wenjing1, SHANG Shili2, YANG Qian1, FENG Yuerong1, LI Jun1,*()   

  1. 1. Department of Nephrology, the First Affiliated Hospital of Kunming Medical University, Kunming 650000, China
    2. Department of Nephrology, Qujing Second People's Hospital, Qujing 655000, China
  • Received:2022-12-20 Revised:2023-02-19 Published:2023-10-15 Online:2023-03-28
  • Contact: LI Jun

摘要: 背景 免疫球蛋白A(IgA)肾病(IgAN)是一种涉及多因素、多基因的慢性炎症疾病,血小板/白蛋白比值(PAR)被认为是一种新型的炎症标志物,但PAR与IgAN的关系尚不清楚。 目的 探究PAR与IgAN临床、病理指标的相关性,并评价PAR在IgAN中的临床意义。 方法 选取2019年10月—2020年8月在昆明医科大学第一附属医院肾内科经肾穿刺活检确诊的210例IgAN患者作为研究对象,回顾性收集患者的一般指标〔性别、年龄、收缩压、舒张压及病程〕,实验室检查指标〔白细胞计数(WBC)、中性粒细胞绝对值(ANC)、淋巴细胞绝对值(ALC)、单核细胞绝对值(AMC)、血小板计数(PLT)、血清白蛋白(ALB)、血尿酸(SUA)、血尿素氮(BUN)、血肌酐(Scr)、IgA、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)、血清补体C3、血清补体C4、尿红细胞数(URBC)、24 h尿蛋白总量(24 h-MTP)、24 h微量白蛋白总量(24 h-mALB)〕,肾穿刺活检病理结果,计算中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、PAR、免疫球蛋白A/补体C3比值(IgA/C3)、免疫球蛋白G/补体C3比值(IgG/C3)、补体C3/补体C4比值(C3/C4)、估算肾小球滤过率(eGFR)。根据PAR百分位数将研究对象分为三组,分别为Q1组(PAR≤5.626 5)、Q2组(5.626 5<PAR≤6.984 3)、Q3组(PAR>6.984 3),每组70例,比较三组基线资料的差异,采用Spearman秩相关分析及多因素Logistic回归分析探究PAR与IgAN临床和病理指标的关系,绘制受试者工作特征(ROC)曲线分析PAR对病理指标的预测价值。 结果 三组患者性别、WBC、ANC、PLT、PLR、PAR、URBC、ALB、IgG/C3、24 h-mALB、24 h-MTP、M病变、Lee分级比较,差异均有统计学意义(P<0.05)。相关性分析结果显示,PAR与PLT、WBC、ANC、PLR、URBC、24 h-mALB、24 h-MTP以及M、E病变、Lee分级呈正相关(P<0.05),与ALB、IgG/C3呈负相关(P<0.05)。多因素Logistic回归分析结果显示,PAR〔OR=2.688,95%CI(1.178,6.135)〕、ALB〔OR=0.736,95%CI(0.587,0.923)〕是IgAN患者M1病变的独立影响因素(P<0.05),ALB〔OR=0.896,95%CI(0.824,0.973)〕是IgAN患者E1病变的独立影响因素(P<0.05)。PAR预测IgAN患者M1、E1病变的ROC曲线下面积分别为0.727、0.599。 结论 PAR与IgAN的临床表现及M、E病变程度存在显著相关,对评估IgAN活动性有一定的临床价值。对高PAR值的IgAN患者可予以更积极的治疗方案,抑制活动性病变,以改善肾脏结局。

关键词: 肾小球肾炎,IgA, IgA肾病牛津病理分型, 血小板/白蛋白比值, 临床病理特征, 影响因素分析

Abstract:

Background

Immunoglobulin A (IgA) nephropathy (IgAN) is a chronic inflammatory illness involving multiple factors and genes, platelet-albumin ratio (PAR) is regarded as a novel marker of inflammation, but the connection between PAR and IgA nephropathy remains unclear.

Objective

To examine the correlation of PAR with the clinicopathological indicators of IgAN and to evaluate the clinical significance of PAR in IgAN.

Methods

From October 2019 to August 2020, 210 patients with IgAN diagnosed by percutaneous renal biopsy at the Department of Nephrology of the First Affiliated Hospital of Kunming Medical University were selected as study subjects, general inforamtion of the included patients (gender, age, systolic blood pressure, diastolic blood pressure and disease duration), laboratory indicators〔white blood cell (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC), platelet count (PLT), serum albumin (ALB), serum uric acid (SUA), blood urea nitrogen (BUN), serum creatinine (Scr), IgA, immunoglobulin M (IgM), immunoglobulin G (IgG), serum complement C3, serum complement C4, urine red blood cell count (URBC), 24 h urinary microalbumin (24 h mALB), 24 h micrototal protein (24 h MTP) 〕, percutaneous renal biopsy pathology results, calculated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), PAR, immunoglobulin A-to-complement C3 ratio (IgA/C3), immunoglobulin G-to-complement C3 ratio (IgG/C3), complement C3-to-complement C4 ratio (C3/C4), and estimated glomerular filtration rate (eGFR) were collected. The study subjects were divided into three groups: group Q1 (PAR≤5.626 5), group Q2 (5.6265<PAR≤6.984 3) and group Q3 (PAR>6.984 3), each group of 70 cases. The differences in the baseline inforamtion among the three groups were compared, Spearman correlation analysis and Logistic regression analysis were used to explore the correlation between PAR and IgAN clinicopathological indicators of IgAN, receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of PAR on pathological indicators.

Results

There were significant differences in gender, WBC, ANC, PLT, PLR, PAR, URBC, ALB, IgG/C3, 24 h-mALB, 24 h-MTP, M lesions, Lee classification among the three groups (P<0.05). Spearman correlation analysis showed that PAR was positively correlated with PLT, WBC, ANC, PLR, URBC, 24 h-mALB, 24 h-MTP, M lesions, E lesionsand Lee classification, and negatively correlated with ALB and IgG/C3 (P<0.05). Multivariate Logistic regression analysis showed that PAR〔OR=2.688, 95%CI (1.178, 6.135) 〕 and ALB〔OR=0.736, 95%CI (0.587, 0.923) 〕 were independent influencing factors for M1 lesions in IgAN patients (P<0.05), ALB〔OR=0.896, 95%CI (0.824, 0.973) 〕 was an independent influencing factor for E1 lesions (P<0.05). The ROC curve showed that area-under-curve (AUC) of PAR predicting M1 and E1 lesions in IgAN patients was 0.727 and 0.599, respectively.

Conclusion

PAR was significantly correlated with the clinical manifestations and the degree of M and E lesions of IgAN, which has clinical significance in evaluating IgAN activity. Patients with high PAR levels should be treated more aggressively to inhibit active lesions and improve renal outcomes.

Key words: Glomerulonephritis, IgA, Oxford classification of IgA nephropathy, Platelet-albumin ratio, Clinicopathological features, Root cause analysis