Particulate matter of air pollution may increase risk of kidney failure in IgA nephropathy
Particulate matter of air pollution may increase risk of kidney failure in IgA nephropathy
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空气污染颗粒物可能增加 IgA 肾病肾衰竭风险
DOI：
10.1016/j.kint.2022.08.020
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发表时间：
2022-11-18
影响因子：
19.6
通讯作者：
Xie, Jingyuan
中科院分区：
文献类型：
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作者：
Luo, Chengwen;Ouyang, Yan;Xie, Jingyuan
IgA肾病(IgAN)是以半乳糖缺陷性IgA1(Gd-IgA1)沉积于肾小球系膜并伴有粘膜免疫紊乱为特征的疾病。由于环境污染与一般人群慢性肾脏疾病的进展有关，我们专门调查了暴露于直径小于2.5 mm的细颗粒物(PM2.5)对IgAN进展的影响。经活检证实的原发性IgAN患者来自7个中国肾脏中心。1998年至2016年PM2.5暴露来自卫星气溶胶光学厚度数据，共有1,979名IgAN患者入选，其中包括994名男性。不同省份患者的PM2.5暴露水平有所不同，但总体上，北方患者的PM2.5暴露水平高于南方患者。不同地区PM2.5暴露的严重程度与地区性肾功能衰竭负担相关。此外，研究前PM2.5年平均浓度每增加10毫克/立方米(危险比1.14；95%可信区间1.06-1.22)或研究后PM2.5暴露时变(1.10；1.01-1.18)，经年龄、性别、估计肾小球滤过率、尿蛋白、尿酸、血红蛋白、平均动脉压、牛津分级、糖皮质激素和肾素-血管紧张素系统阻滞剂治疗调整后，与肾衰竭风险增加相关。当在上述模型的基础上进一步调整时间段、心血管疾病危险因素或城市规模时，相关性很强。因此，我们的结果表明，PM2.5是IgAN患者肾衰竭的独立危险因素，但这些发现需要在更多样化的人群和其他地理区域进行验证。
IgA nephropathy (IgAN) is characterized by deposition of galactose-deficient IgA1 (Gd-IgA1) in glomerular mesangium associated with mucosal immune disorders. Since environmental pollution has been associated with the progression of chronic kidney disease in the general population, we specifically investigated the influence of exposure to fine particulate matter less than 2.5 mm in diameter (PM2.5) on IgAN progression. Patients with biopsy-proven primary IgAN were recruited from seven Chinese kidney centers. PM2.5 exposure from 1998 to 2016 was derived from satellite aerosol optical depth data and a total of 1,979 patients with IgAN, including 994 males were enrolled. The PM2.5 exposure levels for patients from different provinces varied but, in general, the PM2.5 exposure levels among patients from the north were higher than those among patients from the south. The severity of PM2.5 exposure in different regions was correlated with regional kidney failure burden. In addition, each 10 mg/m3 increase in annual average concentration of PM2.5 exposure before study entry (Hazard Ratio, 1.14; 95% confidence interval, 1.06-1.22) or time-varying PM2.5 exposure after study entry (1.10; 1.01-1.18) were associated with increased kidney failure risk after adjustment for age, gender, estimated glomerular filtration rate, urine protein, uric acid, hemoglobin, mean arterial pressure, Oxford classification, glucocorticoid and renin-angiotensin system blocker therapy. The associations were robust when the time period, risk factors of cardiovascular diseases or city size were further adjusted on the basis of the above model. Thus, our results suggest that PM2.5 is an independent risk factor for kidney failure in patients with IgAN, but these findings will require validation in more diverse populations and other geographic regions.