吸烟对特发性膜性肾病患者肾功能及病理变化的影响

Effects of smoking on renal function and pathological changes in idiopathic membranous nephropathy (IMN) patients

目的探讨吸烟在特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者肾功能减退及病理变化中的作用。方法纳入吉林大学第二医院肾病内科2018年4月至2019年8月经皮肾穿刺活检病理确诊为IMN的患者共60例,收集IMN患者的临床资料、实验室检查资料及病理资料,并调查患者的吸烟状况,分析IMN患者吸烟状态与估算肾小球滤过率(estimated glomerular filtration rate,eGFR)及病理指标的关系。结果单因素相关性分析显示,eGFR与吸烟量呈负相关(r=-0.26,P<0.05),肾间质血管总分与吸烟量呈正相关(rs=0.69,P<0.01)。吸烟者肾小管间质纤维化及血管病变更重,多因素二元Logistic回归分析发现吸烟增加IMN患者肾间质纤维化(OR=6.42,P<0.05)、血管壁增厚(OR=4.71,P<0.05)及血管玻璃样变(OR=7.43,P<0.05)的风险。结论吸烟对IMN患者肾功能具有一定的损害作用,是IMN患者肾小管间质纤维化、血管壁增厚及血管玻璃样变的独立危险因素。

Objective To investigate the role of smoking in renal dysfunction and pathological changes in patients with idiopathic membranous nephropathy(IMN).Methods A total of 60 patients with pathological diagnosis of IMN by renal puncture biopsy in the Second Hospital of Jilin University from April 2018 to August 2019 were included.We collected clinical data,laboratory data and pathologic data of these patients,estimated glomerular filtration rate(eGFR),investigated IMN patients with smoking status,and analyzed the smoking status of IMN patients and the relationship between eGFR and pathological indicators.Results Single-factor correlation analysis showed that eGFR was negatively correlated with smoking(r=-0.26,P<0.05),and the total renal interstitial vascular score was positively correlated with smoking(r s=0.69,P<0.01).Renal tubulointerstitial fibrosis and vascular disease were more severe in smokers,multivariate binary Logistic regression analysis revealed that smoking increased the risk of renal interstitial fibrosis(OR=6.42,P<0.05),vascular wall thickening(OR=4.71,P<0.05)and vitreous degeneration of blood vessels(OR=7.43,P<0.05)in IMN patients.Conclusions Smoking has a certain damage effect on renal function of IMN patients,and is an independent risk factor for renal tubulointerstitial fibrosis,vascular wall thickening and vitreous degeneration of blood vessels in IMN patients.