| IgA肾病患者血清胱抑素C对早期肾小管间质损害的预测作用 |
| 投稿时间：2015-02-11 修订日期：2015-02-28 点此下载全文 |
| 引用本文：范燕琴,丁国华,陈星华,王惠明.IgA肾病患者血清胱抑素C对早期肾小管间质损害的预测作用[J].医学研究杂志,2015,44(8):21-25 |
| DOI：
10.11969/j.issn.1673-548X.2015.08.008 |
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| 基金项目:国家自然科学基金资助项目(81370800) |
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| 中文摘要:目的 探讨IgA肾病(IgAN)患者血清胱抑素C(serum cystatin C, ScysC)水平与肾小管间质损害(tubulointerstitial leisions, TIL)的相关关系,评估ScysC预测IgAN患者TIL程度的临床价值。 方法 回顾性分析2012年6月~2014年7月在笔者医院住院资料完整,经肾活检病理诊断为原发性IgAN患者220例,记录患者临床资料。将纳入病例分3组:①全组;②肾功能正常组[eGFR≥90ml/(min·1.73m2)];③肾功能下降组[eGFR<90ml/(min·1.73m2)]。3组按IgAN牛津分型肾小管萎缩/间质纤维化(T)评分分为亚组T0/T1/T2:①T0:0~25%;②T1:26% ~50%;③T2:>50%;3组按T是否>25%分为亚组T(+)/T(-):①T(+):0~25%;②T(-):>25%。单因素方差分析各亚组间ScysC水平有无统计学差异;Spearman等级相关分析各亚组ScysC水平与IgAN患者TIL相关性;多因素Logistic回归分析ScysC能否作为TIL的独立危险因素;ScysC预测TIL的效能用受试者工作特征(ROC)曲线下面积(AUC)评价。 结果 ScysC水平在各亚组间差异均有统计学意义(P<0.05),ScysC水平越高,TIL程度越重;ScysC水平在T0/T1/T2组与T相关系数分别为(r=0.563, P<0.01;r=0.299, P<0.05;r=0.498, P<0.05),在T(+)/T(-)组与T相关系数分别为(r=0.490, P<0.01;r=0.264, P<0.05;r=0.283, P<0.05); Logistic回归显示ScysC是预测T>25%事件的主要危险因素;ROC曲线分析显示在eGFR≥90ml/(min·1.73m2)组,ScysC在T>25%事件发生的AUC为0.654(95%CI:0.497~0.812,P<0.01),ScysC水平中位数为0.93mg/L,其作为界值预测T>25%事件的敏感度为85%,特异性为57.1%。 结论 血清胱抑素C水平越高,IgAN患者肾小管间质损害程度越重,血清胱抑素C可作为预测肾小管间质损害程度的有效无创性生物学指标。 |
| 中文关键词:IgA肾病 肾小管间质损害 胱抑素C 牛津分型 |
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| Analysis of Cystatin C to Predict Tubular Interstitial Leisions at Early Stage of IgA Nephropathy |
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| Abstract:Objective To investigate the relationship between the serum level of cystatin C (ScysC) and the tubulointerstitial leisions (TIL)at early stage of IgA nephropathy,looking for a new and effective biological prediction method for the TIL. Methods A total of 220 biopsy-proven primary IgA patients were retrospectively recruited.Baseline clinical data were recorded.Patients were divided into 3 groups:the whole cohort,normal baseline eGFR[eGFR≥90ml/(min·1.73m2)],decreased baseline eGFR[eGFR<90ml/(min·1.73m2)]. On the basis of the percentage of tubular atrophy /interstitial fibrosis according to Oxford classification system of IgAN,each group was subdivided into subgroups T0/T1/T2:①T0:0-25%;②T1:26%-50%;③T2:>50%;and each group was re-attributed by 25% tubular atrophy /interstitial fibrosis into subgroups T(+)/T(-):①T(+):≤25%;②T(-):T>25%. Statistical difference of ScysC level among these subgroups were analyzed with One-way analysis of variance.Correlation of ScysC levels and TIL in each groups was analyzed with Spearman's correlation. Logistic regression was performed to detect whether ScysC was a predictor of TIL.The forecast performance of ScysC to predict TIL was evaluated by using receiver operating characteristic(ROC)curves and area under curves(AUC). Results The difference of ScysC level between the subgroups were significant(P<0.05)in the three groups respectively.High ScysC levels indicated higher tubulointerstitial scores by the Oxford system. ScysC was positively correlated to tubulointerstitial scores in subgroups T0/T1/T2 (r=0.563,P<0.01;r=0.299,P<0.05;r=0.498,P<0.01). ScysC was positively correlated to tubulointerstitial scores in subgroups T(+)/T(-) (r=0.490, P<0.01;r=0.264,P<0.05;r=0.283,P<0.05).Logistic regression analysis demonstrated that increased ScysC was the independent risk factor of having more than 25% TIL(β=2.86,OR=17.405 95% CI:4.468-67.797, P<0.05). AUC of using ScysC to predict having more than 25% TIL in the normal baseline eGFR group was 0.654 (95%CI:0.497-0.812,P<0.01).The cut-off values of ScysC for predicting more than 25% TIL was 0.93mg/L,with a sensitivity of 85% and a specificity of 57.1%. Conclusion Higher ScysC levels indicated more severe tubulointerstitial leisions. ScysC can be used as a reliable biomarker to predict the risk of having more severe tubulointerstitial damage. |
| keywords:IgA nephropathy Tubulointerstitial lesions Cystatin C Oxford classification |
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