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Title: [Effect of serum IgA/C3 and glomerular C3 staining on clinical prognosis in patients with IgA nephropathy].
Author: Pei GQ, Qin AY, Wang SQ, Tan L, Tang Y, Qin W.
Journal: Zhonghua Yi Xue Za Zhi; 2020 Aug 11; 100(30):2372-2377. PubMed ID: 32791814.
Abstract:
Objective: To investigate the effects of serum immunoglobulin A/complement factor 3 (IgA/C3) ratio and glomerular C3 staining on clinical prognosis in patients with IgA nephropathy. Methods: From January 1st, 2007 to December 30th, 2016, a total of 519 patients with biopsy-proven IgA nephropathy (IgAN) in West China Hospital were retrospectively reviewed and divided into four groups based on serum IgA/C3 ratio and glomerular C3 staining: group A with IgA/C3 ratio ≥3.046 (median) and glomerular C3 staining ≥2 (n=151), group B with IgA/C3 ratio ≥3.046 and glomerular C3 staining<2 (n=109), group C with IgA/C3 ratio<3.046 and glomerular C3 staining ≥2 (n=119), and group D with IgA/C3 ratio<3.046 and glomerular C3 staining<2 (n=140). Clinical data, pathological characteristics and the primary endpoint [≥ 50% decline in estimated glomerular filtration rate (eGFR) and/or end-stage renal disease (ESRD)]were collected. Clinical prognosis and relevant risk factors were analyzed among the four groups. Results: Totally, 519 patients (298 males, 57.4%) with an average age of (33.6±10.9) years were recruited and followed up for (43.4±21.6) months. The rate of complete remission plus partial remission was 74.2% (112/151), 74.3% (81/109), 72.3% (86/119), 81.4% (114/140) in group A, B, C, D, respectively. Meanwhile, The rate of ESRD was highest in group A (14.6% vs 9.2%, 13.4%, 8.6%). Renal outcome (patients reached the endpoint) was worse in group A and C compared with group B and D (15.2%, 16.0 vs 8.3%, 7.9%). Moreover, 80-month renal survival rate was significantly worse in group A (84.8%) than that in group B and D (91.7% and 92.1%), but no statistical significant difference was found between group A and B (P(AB)=0.085; P(AD)=0.028). There was no significant difference of renal survival rate between group A and C (84.8% vs 84.0%, P=0.896). Multivariate Cox model showed that hypertension (HR=2.753, 95%CI: 1.452-5.217, P=0.002), serum creatinine (HR=1.011, 95%CI: 1.008-1.014, P<0.001), and tubular atrophy/interstitial fibrosis (T1/T2) (HR=6.595, 95%CI: 3.107-13.999, P<0.001) were independent predictors of poor renal survival. Conclusion: Serum IgA/C3 ratio and glomerular C3 staining are predictors of renal clinical prognosis in patients with IgA nephropathy. 目的： 探讨IgA肾病（IgAN）患者血清IgA/C3比值和病理C3沉积与临床预后的关系。 方法： 纳入2007年1月1日至2016年12月30日于四川大学华西医院经皮肾穿刺活检确诊的原发性IgAN患者519例，根据肾穿刺活检时血清学及病理结果将患者分为4组：A组（151例）血清IgA/C3比值≥3.046（中位数）且肾小球C3染色≥2；B组（109例）血清IgA/C3比值≥3.046且肾小球C3染色<2；C组（119例）血清IgA/C3比值<3.046且肾小球C3染色≥2；D组（140例）血清IgA/C3比值<3.046且肾小球C3染色<2。收集患者临床资料、病理特征、随访终点[估算肾小球滤过率（eGFR）下降≥50%和（或）终末期肾脏病（ESRD）]，分析各组患者的临床预后及相关因素。 结果： 519例患者中男298例（57.4%），年龄（33.6±10.9）岁，随访（43.4±21.6）个月。A、B、C、D组的完全缓解+部分缓解率分别为74.2%（112/151）、74.3%（81/109）、72.3%（86/119）、81.4%（114/140），A组达到ESRD的患者比例最高（14.6%与9.2%、13.4%、8.6%）；A组、C组达到复合终点的患者比例高于B、D两组（15.2%、16.0与8.3%、7.9%）。Kaplan-Meier生存曲线显示A组的80个月肾脏存活率为84.8%，低于B组、D组的91.7%、92.1%，但是与B组比较差异无统计学意义（P(AB)=0.085；P(AD)=0.028）；A组与C组肾脏存活率相近，差异无统计学意义（84.8%比84.0%，P=0.896）。多因素Cox回归分析提示高血压（HR=2.753，95%CI：1.452~5.217，P=0.002）、血肌酐（HR=1.011，95%CI：1.008~1.014，P<0.001）和肾小管萎缩或肾间质纤维化（T1/T2）（HR=6.595，95%CI：3.107~13.999，P<0.001）是肾脏存活的不良预后因素。 结论： 血清IgA/C3和肾小球C3染色可以帮助预测IgAN的治疗效果和临床预后。.

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