吸烟对IgA肾病(IgAN)患者肾功能和肾小管间质及血管病变的影响

Effect of cigarette smoking on renal function and renal tubulointerstitialvascular lesions in primary IgA nephropathy(IgAN) patients

目的探讨吸烟在IgA肾病患者肾功能减退和肾小管间质及血管病变中的作用。方法纳入2011年3月至2012年7月间113例经肾活检诊断为原发性IgA肾病的患者,分析其吸烟状态与估算肾小球滤过滤(estimated glomerular filtration rate,eGFR)及病理指标的关系。结果 113例IgA肾病患者中吸烟者38例,其中既往吸烟者12例、目前吸烟者26例。吸烟者eGFR显著低于非吸烟者(P=0.000)。多重线性回归分析显示,吸烟与eGFR(β=-0.220,P=0.031)呈负相关。吸烟者肾小管间质及血管病变更重,表现为间质炎细胞浸润积分(P=0.023)、间质纤维化积分(P=0.000)、肾小管萎缩积分(P=0.003)和血管壁增厚积分(P=0.004)显著高于非吸烟者。多因素二元Logistic回归分析提示吸烟增加患者肾间质纤维化的风险(OR=4.874,P=0.020)。进一步采用有序Logistic回归分析,发现吸烟与肾间质纤维化积分呈正相关(6=1.747,P=0.004)。Pearson和Spearman单因素相关分析显示,吸烟量与eGFR呈显著负相关(r=-0.308,P=0.001),与肾间质纤维化积分(r_s=0.428,P=0.000)、小管萎缩积分(r_s=0.284,P=0.003)、炎细胞浸润积分(r_s=0.232,P=0.016)、血管壁增厚积分(r_s=0.264,P=0.006)呈显著正相关。结论吸烟是IgA肾病患者肾功能减退程度及肾间质纤维化的独立危险因素,且随着吸烟量增大,可能会增加IgA肾病患者肾功能减退及病理损伤的程度。

Objective To illuminate the effect of cigarette smoking on renal function and renal tubulointerstitial-vascular lesions in IgA nephropathy （IgAN） patients.Methods We analyzed the role of cigarette smoking in renal function and tubulointerstitialvascular lesions in 113 biopsyproved IgAN patients.Results There were 38 smokers in 113 IgAN patients,including 12 exsmokers and 26 current smokers.Smokers had lower estimated glomerular filtration rate （eGFR） than nonsmokers （P=0.000）.Multiple linear regression analysis revealed that smoking （β=-0.220,P=0.031） were correlated significantly with lower eGFR.Index of interstitial cell infiltration （P=0.023）,interstitial fibrosis （P=0.000）,tubular atrophy （P=0.003） and intra-renal vessel wall thickening （P=0.004） were higher in smokers than nonsmokers.Multiple binary logistic regression analyses revealed that cigarette smoking correlated with the presence of interstitial fibrosis （OR=4.874,P=0.020）.Multiple ordinal regression analysis revealed that cigarette smoking were correlated significantly with higher index of interstitial fibrosis （β=1.747, P=0.004）.The accumulated smoking amount was negatively correlated with eGFR （r=-0.308,P=0.001） and positively correlated with index of interstitial fibrosis （rs=0.428,P=0.000）,index of tubular atrophy （rs=0.284,P=0.003）,index of interstitial cell infiltration （rs=0.232,P=0.016） and index of intrarenal vessel wall thickening （rs=0.264,P=0.006）.Conclusions Smoking was an independent risk factor of eGFR decline and interstitial fibrosis in IgAN patients.The accumulated smoking amount could be correlated with severity of renal function deterioration and pathological lesions.