Plasma galactose-deficient immunoglobulin A1 and loss of kidney function in patients with immunoglobulin A vasculitis nephritis
Plasma galactose-deficient immunoglobulin A1 and loss of kidney function in patients with immunoglobulin A vasculitis nephritis
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免疫球蛋白 A 血管炎肾炎患者血浆半乳糖缺乏免疫球蛋白 A1 和肾功能丧失
DOI：
10.1093/ndt/gfz151
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发表时间：
2020-12-01
影响因子：
6.1
通讯作者：
Zhang, Hong
中科院分区：
文献类型：
--
作者：
Zhang, Xue;Xie, Xinfang;Zhang, Hong
背景免疫球蛋白A（伊加）血管炎性肾炎（IgAV-N）是最常见的继发性伊加肾病（IgAN）。许多研究表明，IgA 1铰链区的半乳糖缺陷型IgA 1（Gd-IgA 1）与原发性IgAN的发生和进展有关。在这项研究中，我们的目的是评估Gd-IgA 1在IgAV-N患者的大型中国队列中肾脏疾病进展中的作用。该队列研究入组了112例IgAV-N患者，15例无肾脏受累的伊加血管炎（IgAV）患者和108例IgAN患者。采用酶联免疫吸附试验测定肾活检时血浆IgA 1和Gd-IgA 1水平。主要终点是估计肾小球滤过率下降30%或终末期肾病或死亡。IgAV-N和IgAN患者血清中Gd-IgA_1水平均高于健康对照组（平均值+/- SD，分别为302.86 +/- 54.93 U/mL vs 303.16 +/- 59.43 U/mL vs 281.30 +/- 43.74 U/mL; P = 0.047），以及与无肾脏受累的IgAV患者（272.65 +/- 53.14 U/mL; P = 0.036）相比。在调整临床数据后，发现较高水平的Gd-IgA 1与肾衰竭风险较高独立相关[风险比（HR）= 1.703/1 SD，95%置信区间（CI）1.233-2.352; P = 0.001]。与Gd-IgA 1四分位数第一组（作为参考）相比，Gd-IgA 1四分位数第四组保留了肾功能不良的预测值（HR = 3.740，95%CI 1.204-11.619; P = 0.023）。这些数据表明，Gd-IgA 1水平在IgAN成人患者和IgAV-N成人患者中同样升高。此外，Gd-IgA 1水平增加与IgAV-N的发展和进展相关，如在IgAN中观察到的。
Background. Immunoglobulin A (IgA) vasculitis nephritis (IgAV-N) is the most common secondary IgA nephropathy (IgAN). Many studies have demonstrated that galactose-deficient IgA1 (Gd-IgA1) in the IgA1 hinge region is associated with the development and also progression of primary IgAN. In this study, we aimed to evaluate the roles of Gd-IgA1 in kidney disease progression in a large Chinese cohort of IgAV-N patients.Methods. This cohort study enrolled 112 patients with IgAV-N, 15 patients with IgA vasculitis (IgAV) without kidney involvement and 108 patients with IgAN. Plasma IgA1 and Gd-IgA1 levels at kidney biopsy were measured by enzyme-linked immunosorbent assay. The primary endpoint was a 30% decline in estimated glomerular filtration rate or end-stage renal disease or death.Results. The levels of Gd-IgA1 in IgAV-N and IgAN patients were higher than in healthy controls (mean +/- SD, 302.86 +/- 54.93 U/mL versus 303.16 +/- 59.43 U/mL versus 281.30 +/- 43.74 U/mL, respectively; P = 0.047), as well as compared with those with IgAV without kidney involvement (272.65 +/- 53.14 U/mL; P = 0.036). After adjusting clinical data, higher levels of Gd-IgA1 were found to be independently associated with a greater risk for kidney failure [hazard ratio (HR) = 1.703 per 1 SD, 95% confidence interval (CI) 1.233-2.352; P = 0.001]. Compared with the first Gd-IgA1 quartile group (as reference), the fourth Gd-IgA1 quartile group retained a predictive value for poor renal outcome (HR = 3.740, 95% CI 1.204-11.619; P = 0.023).Conclusions. These data indicate that Gd-IgA1 levels were similarly elevated in adult patients with IgAN and those with IgAV-N. Moreover, increased Gd-IgA1 levels were associated with both the development and progression of IgAV-N, as observed in IgAN.