Lower serum bilirubin is associated with poor renal outcome in IgA nephropathy patients.
Lower serum bilirubin is associated with poor renal outcome in IgA nephropathy patients.
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DOI：
10.7150/ijms.60111
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发表时间：
2021
影响因子：
3.6
通讯作者：
Qin W
中科院分区：
文献类型：
--
作者：
Jiang Z;Tan J;Wang S;Dong L;Han X;Tang Y;Qin W
伊加肾病（IgAN）是世界范围内最常见的原发性肾小球肾炎。本研究旨在探讨血清胆红素与IgA肾病患者肾脏预后的关系。研究方法：共收集1492例经活检证实的IgAN患者，根据血清胆红素中位数分为低胆红素组（血清胆红素≤9.7umol/L，n=753）和高胆红素组（血清胆红素>9.7umol/L，n=739）。在肾活检时评估基本临床特征，并分析血清胆红素与联合终点的关系。联合终点定义为估计肾小球滤过率（e-GFR）下降50%、终末期肾病（ESKD）、肾移植和/或死亡。此外，然后进行倾向评分匹配（PSM），以改善不同组患者之间的平衡并模拟随机化。采用Kaplan-Meier生存分析探讨血清胆红素在IgAN进展中的作用。建立3个临床病理模型进行多因素考克斯回归分析，评价血清胆红素与IgAN肾预后的关系。结果：在中位5年随访期内，Kaplan-Meier分析显示差异有统计学意义。在不匹配组中，189例（12.7%）患者进展至肾脏联合终点。其中低胆红素组122例（16.2%），高胆红素组67例（9.1%）（P<0.001）。PSM后，134例（11.8%）患者达到联合终点，其中低胆红素组566例患者中有77例（14.6%），高胆红素组566例患者中有57例（10.1%）（p=0.039）。人口统计学、病理学、临床指标和血清胆红素3个模型的结果显示，在非匹配和匹配队列中，基础血清胆红素水平越低，IgAN患者达到联合终点的风险越高。结论：血清胆红素水平可能与IgA肾病的进展呈负相关。
Aims: IgA nephropathy (IgAN) is the most prevalent primary glomerulonephritis worldwide. We conducted this study to explore the relationship between serum bilirubin and renal outcome of patients with IgAN. Methods: A total of 1492 biopsy proven IgAN patients were recruited and divided into two groups according to their median serum bilirubin concentration: the low bilirubin group (serum bilirubin≤9.7umol/L, n=753) and high bilirubin group (serum bilirubin>9.7umol/L, n=739). Basic clinical characteristics were assessed at the time of renal biopsy and the relationships between serum bilirubin and the combined endpoints were analyzed. The combined endpoints were defined as a 50% decline in estimate glomerular filtration rate (e-GFR), end-stage kidney disease (ESKD), renal transplantation and/or death. In addition, propensity score matching (PSM) was then performed to improve balance and simulate randomization between patients in different groups. Kaplan-Meier survival analysis was applied to explore the role of serum bilirubin in the progression of IgAN. Three clinicopathological models of multivariate Cox regression analysis were established to evaluate the association of serum bilirubin and renal prognosis of IgAN. Results: During median 5-year follow-up period, significant differences were shown in Kaplan-Meier analysis. In the unmatched group, 189 (12.7%) patients progressed to the renal combined endpoints. Among this, 122 in 753 patients (16.2%) were in low bilirubin group and 67 in 739 patients (9.1%) were in high bilirubin group (p<0.001). After PSM, there were 134 (11.8%) patients reached the combined endpoints, which included 77 in 566 patients (14.6%) in low bilirubin group and 57 in 566 patients (10.1%) in high bilirubin group (p=0.039). The results of three models (including demographics, pathological, clinical indicators and serum bilirubin) demonstrated that a lower basic serum bilirubin level was significantly associated with a higher risk of reaching combined endpoints in IgAN patients both in unmatched and matched cohort. Conclusion: Serum bilirubin level may be negatively associated with the progression of IgAN.
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