The correlation of interstitial change with renal prognosis in patients with myeloperoxidase-ANCA-associated glomerulonephritis: a single-center retrospective analysis
The correlation of interstitial change with renal prognosis in patients with myeloperoxidase-ANCA-associated glomerulonephritis: a single-center retrospective analysis
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DOI：
10.1007/s10067-023-06753-y
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发表时间：
2023-08-30
影响因子：
3.4
通讯作者：
Han，Fei
中科院分区：
文献类型：
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作者：
Kong，Weiwei;Wang，Jiahui;Han，Fei
目的探讨活动性/慢性肾小管间质损伤与肾存活率的相关性，并比较其对髓过氧化物酶（MPO）-抗中性粒细胞胞浆抗体（ANCA）相关性肾小球肾炎（AAGN）患者的预测价值。方法纳入2004年2月至2020年12月期间确诊的225例MPO-AAGN患者。生存和单变量/多变量考克斯回归分析被用来分析间质炎症和间质纤维化/肾小管萎缩（IF/TA）的预后价值。结果在225例患者中，73例（32.4%）患者发展为终末期肾病（ESRD），需要维持透析。多因素考克斯回归分析显示，间质性炎症>50%和IF/TA>50%是MPO-AAGN患者发生ESRD的重要预测因素，这些因素经年龄、性别、估计肾小球滤过率（eGFR）≤15 ml/min/1.73 m2和正常肾小球百分比（按<25%、25- 50%、>50%分类）校正。进一步进行分层考克斯回归分析，发现eGFR>15 ml/min/1.73 m2和eGFR≤15 ml/min/1.73 m2亚组的结果不同。在eGFR>15 ml/min/1.73m2的亚组中，间质炎症>50%和IF/TA>50%是ESRD的显著危险因素，而在eGFR≤15 ml/min/1.73m2的亚组中无显著性或不太显著。间质炎症>50%/≤50%和IF/TA>50%/≤50%的生存分析显示，eGFR>15 ml/min/1.73m2的亚组间差异有统计学意义，而eGFR≤15 ml/min/1.73m2的亚组间差异无统计学意义或不太显著。结论间质炎症>50%和IF/TA>50%是影响MPO-AAGN肾生存的预后因素。特别是在eGFR>15 ml/min/1.73m2的亚组中，间质炎症和IF/TA具有更好的预测能力。要点·间质炎症>50%和IF/TA>50%有助于预测MPO-AAGN患者的肾存活。eGFR>15 ml/min/1.73m2亚组间质炎症和IF/TA的预测能力均优于eGFR≤15 ml/min/1.73m2亚组。
ObjectsWe aim to explore the correlation between active/chronic tubulointerstitial injury and renal survival, and to compare their predictive value in patients with myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN).MethodA total of 225 patients with MPO-AAGN diagnosed between February 2004 and December 2020 were included. Survival and univariate/multivariate Cox regression analyses were used to analyze the prognostic value of interstitial inflammation and interstitial fibrosis/tubular atrophy (IF/TA).ResultsOf the 225 patients, 73 (32.4%) patients developed end-stage renal disease (ESRD) requiring maintenance dialysis. Interstitial inflammation>50% and IF/TA>50% were important predictors for ESRD in MPO-AAGN in multivariate Cox regression analysis adjusted by age, gender, estimated glomerular filtration rate (eGFR)≤15 ml/min/1.73m2, and normal glomeruli% (classified by <25%, 25–50%, >50%). Furthermore, we conducted stratified Cox regression analysis and found different results in the subgroups of eGFR>15 ml/min/1.73m2and eGFR≤15 ml/min/1.73m2. Interstitial inflammation>50% and IF/TA>50% were significant risk factors for ESRD in the subgroup of eGFR>15 ml/min/1.73m2, but not or less significant in the subgroup of eGFR≤15 ml/min/1.73m2. Similarly, the survival analysis according to interstitial inflammation>50%/≤50% and IF/TA>50%/≤50% showed significant differences in the subgroup of eGFR>15 ml/min/1.73m2, but not or less significant in the subgroup of eGFR≤15 ml/min/1.73m2.ConclusionsInterstitial inflammation>50% and IF/TA>50% were prognostic factors for renal survival in MPO-AAGN. In particular, interstitial inflammation and IF/TA had a better predictive ability in the subgroup of eGFR>15 ml/min/1.73m2.Key Points•Interstitial inflammation>50% and IF/TA>50% can help to predict renal survival in MPO-AAGN.•Both interstitial inflammation and IF/TA had a better predictive ability in the subgroup of eGFR>15 ml/min/1.73m2than those in the subgroup of eGFR≤15 ml/min/1.73m2.