Clinical value of systemic symptoms in IgA nephropathy with ANCA positivity
Clinical value of systemic symptoms in IgA nephropathy with ANCA positivity
复制标题
ANCA阳性IgA肾病全身症状的临床价值
DOI：
10.1007/s10067-017-3931-z
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发表时间：
2018-07-01
影响因子：
3.4
通讯作者：
Zhang, Jingbo
中科院分区：
文献类型：
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作者：
Xie, Lijiao;He, Jianghua;Zhang, Jingbo
我们的目的是评估抗中性粒细胞胞浆抗体（ANCAs）在IgA肾病（IgAN）患者中的致病作用。回顾性分析了2390例活检证实的IgAN患者。纳入35例合并ANCA的IgAN患者和40例未合并ANCA的IgAN患者。根据伯明翰血管炎活动评分（BVAS）项目，将anca阳性患者进一步分为有和无系统性症状的两个亚组。累积肾存活率采用Kaplan-Meier分析计算。组间比较采用对数秩检验。在35例anca阳性患者中，14例（40%）有全身性症状。与无全身性症状的anca阳性患者相比，有全身性症状的anca阳性患者病程较短（1.0 [IQR, 0.3 ~ 6.8] vs. 6.0 [IQR, 2.0 ~ 21.0]，P= 0.011）；eGFR （24.2 [IQR, 11.7-74.9]比100.1 [IQR, 59.6-130.2] mL/min/1.73 m2，P= 0.002）、血清白蛋白（30.4 [IQR, 27.4-34.8]比41.5 [IQR, 35.1-44.4] g/L，P= 0.001）、血红蛋白（96.1±21.5比118.2±22.4 g/L，P= 0.006）水平较低，肾功能较差；肾功能迅速恶化（28.6%比0.0%，P= 0.039）和中重度肾小管萎缩（78.6比23.8%，P= 0.001）的发生率相对较高。Kaplan-Meier分析显示，有全体性症状的anca阳性患者与无全体性症状的anca阳性患者和anca阴性患者相比，累积肾生存率较低（log rank = 14.40，P< 0.001）。评估全身症状是预测ANCA在IgAN中的致病作用的一种简单、容易获得的临床工具。
Our aim was to evaluate the pathogenic role of anti-neutrophil cytoplasmic antibodies (ANCAs) in patients with IgA nephropathy (IgAN). A total of 2390 patients with biopsy-confirmed IgAN were analyzed retrospectively. Thirty-five IgAN patients with ANCA and 40 IgAN patients without ANCA were enrolled. According to the Birmingham Vasculitis Activity Score (BVAS) items, the ANCA-positive patients were further divided into two subgroups which with or without systemic symptoms. The cumulative renal survival rate was calculated using Kaplan–Meier analysis. Comparisons between groups were made using the log rank test. Among the 35 ANCA-positive patients, 14 (40%) had systemic symptoms. Compared with ANCA-positive patients without systemic symptoms, ANCA-positive patients with systemic symptoms had a shorter duration of disease (1.0 [IQR, 0.3–6.8] vs. 6.0 [IQR, 2.0–21.0],P= 0.011); showed worse renal function with lower levels of eGFR (24.2 [IQR, 11.7–74.9] vs. 100.1 [IQR, 59.6–130.2] mL/min/1.73 m2,P= 0.002), serum albumin (30.4 [IQR, 27.4–34.8] vs. 41.5 [IQR, 35.1–44.4] g/L,P= 0.001), and hemoglobin (96.1 ± 21.5 vs. 118.2 ± 22.4 g/L,P= 0.006); and presented relatively higher incidences of rapidly deteriorating kidney function (28.6 vs. 0.0%,P= 0.039) and moderate-to-severe tubular atrophy (78.6 vs. 23.8%,P= 0.001). Kaplan–Meier analysis had shown that ANCA-positive patients with systemic symptoms had lower cumulative renal survival rate compared with both ANCA-positive patients without systemic symptoms and ANCA-negative patients (log rank = 14.40,P< 0.001). Evaluation of systemic symptoms is a simple, readily available clinical tool to predictive the pathogenic role of ANCA in IgAN.