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维生素D缺乏与IgA肾病患者肾脏预后的关系
作者:
中图分类号:
R692.3
基金项目:
江苏省医学创新团队(CXTDA2017011) Relationship between vitamin D deficiency and renal prognosis in patients with IgA nephropathy
Author:
摘要:
目的：探讨IgA肾病(IgA nephropathy，IgAN)患者维生素D水平与肾脏预后的关系。方法：回顾性收集和分析2014年 1月—2019年3月在南京医科大学第一附属医院经肾活检确诊的IgAN患者的一般临床资料及病理检查结果。将入选者分为 25(- OH)D缺乏组和25(- OH)D非缺乏组。研究终点事件定义为肾功能进展，即血清肌酐翻倍或发生终末期肾病。Kaplan-Meier 生存曲线法比较两组 IgAN 患者肾功能进展的差异。采用 Cox 回归法分析肾脏不良预后的影响因素。结果：共 646 例 IgAN 患者入选本研究，25-(OH)D 缺乏组 485 例(75.08%)，25-(OH)D 非缺乏组 161 例(24.92%)。与 25-(OH)D 非缺乏组比较，25-(OH)D缺乏组患者血红蛋白、血白蛋白、血IgA、血IgG水平较低(均P ＜ 0.05)；总胆固醇、尿蛋白定量较高(均P ＜ 0.05)。 Kaplan-Meier生存曲线分析结果显示，25(- OH)D缺乏组患者肾功能进展率高于非缺乏组(log-rank检验χ2 =4.217，P=0.040)。多因素 Cox 回归分析结果显示，25-(OH)D 缺乏是肾脏不良预后的独立危险因素(HR=0.976，95%CI：0.958~0.995，P=0.014)。 结论：高水平25(- OH)D对IgAN患者肾脏预后具有独立保护作用，提示低25(- OH)D患者需要补充维生素D。
Abstract:
Objective：To investigate the relationship between vitamin D level and renal prognosis in patients with IgA nephropathy (IgAN). Methods：The general clinical data and pathological findings of IgAN patients diagnosed by renal biopsy in the First Affiliated Hospital of Nanjing Medical University from January 2014 to March 2019 were collected and analyzed retrospectively. The participants were divided into 25-(OH)D deficiency group and 25-(OH)D non-deficiency group. The end-point event was defined as progression of renal function，a doubling of serum creatinine or the onset of end-stage kidney disease(ESRD). The differences of renal function progression between 25-(OH)D deficiency group and 25-(OH)D non-deficiency group in IgAN patients were compared by Kaplan -Meier survival curve. Cox regression method was used to analyze the influencing factors of poor renal prognosis. Results：A total of 646 IgAN patients were enrolled in this study，there were 485 cases in 25-(OH)D deficiency group(75.08%)and 161 cases in 25-(OH)D non -deficiency group(24.92%). Compared with the 25-(OH)D non -deficiency group，the levels of hemoglobin，serum albumin，blood IgA and blood IgG were lower，and the levels of total cholesterol and urinary protein were higher in the 25-(OH)D deficiency group. The results of Kaplan-Meier survival curve analysis showed that the progressive rate of renal function in the 25(- OH)D deficiency group was higher than that in the non-deficiency group(log-rank test χ2 =4.217，P=0.040). The results of multivariate Cox regression analysis showed that 25-(OH)D deficiency was an independent factor affecting poor renal prognosis(HR=0.976，95%CI： 0.958~0.995，P=0.014). Conclusion：High level of 25-(OH)D has independent protective effect on renal prognosis in patients with IgAN. It implies that patients with low 25(- OH)D need supplementation of vitamin D. |
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