幽门螺杆菌感染对IgA肾病患者24h-UP、mAlb、BLD、IgA1及肾脏生存率的影响

Effects of Helicobacter pylori infection on 24h-UP, mAlb, BLD, IgA1 and renal survival rate in patients with IgA nephropathy

目的探究幽门螺杆菌(Hp)感染对免疫球蛋白A(IgA)肾病患者24h尿蛋白定量(24h-UP)、尿微量清蛋白(mAlb)、尿红细胞(BLD)、免疫球蛋白A1(IgA1)及肾脏生存率的影响。方法回顾性分析2014年2月-2017年5月滨州医学院附属医院收治的211例IgA肾病患者临床资料,根据其Hp感染情况分为Hp感染组(86例)及非Hp感染组(125例)。比较两组基线资料、尿生化指标(24h-UP、mAlb、BLD)、血清IgA1、人半乳糖缺乏IgA1(Gd-IgA1)、白细胞介素-17(IL-17)及外周血T淋巴细胞亚群(Th17/CD4^+、Treg/CD4^+、Th17/Treg)水平,并对患者进行2年随访,采用Kaplan-Meier法绘制两组2年肾脏生存曲线,使用Log-rank法比较两组2年肾脏生存率差异。结果 Hp感染组急性肠胃炎患病率高于非Hp感染组(P<0.05)。Hp感染组尿生化指标(24h-UP、mAlb、BLD)、血清IgA1、Gd-IgA1、IL-17及Th17/CD4^+、Th17/Treg均高于非Hp感染组(P<0.05),Treg/CD4^+低于非Hp感染组(P<0.05)。Hp感染组2年肾脏生存率为90.70%,低于非Hp感染组98.40%(P<0.05)。结论 Hp感染可通过影响Th17/Treg平衡、IgA1异常糖基化等途径,参与IgA肾病病情进展,改变预后状况,临床应积极防控Hp感染情况,以改善IgA肾病诊疗现状。

OBJECTIVE To explore the effects of Helicobacter pylori(Hp) infection on 24 h urine protein quantitation(24 h-UP), urinary microalbumin(mAlb), urinary red blood cells(BLD), immunoglobulin A1(IgA1) and renal survival rate in patients with immunoglobulin A(IgA) nephropathy. METHODS The clinical data of 211 patients with IgA nephropathy admitted to Binzhou Medical University Hospital from Feb. 2014 to May 2017 were retrospectively analyzed. According to their Hp-infection status, they were divided into the Hp infection group(86 cases) and non-Hp infection group(125 cases). Baseline data, urinary biochemical parameters(24 h-UP, mAlb, BLD), serum IgA1, human galactose deficiency IgA1(Gd-IgA1), interleukin-17(IL-17) and peripheral blood T lymphocyte subsets of Th17/CD4^+, Treg/CD4^+ and Th17/Treg were compared between the two groups, and patients were followed up for 2 years. Kaplan-Meier method was used to draw the 2-year renal survival curves. Log-rank method was used to compare difference of the 2-year renal survival rate. RESULTS The prevalence rate of acute gastroenteritis in the Hp infection group was significantly higher than that in the non-Hp infection group(P<0.05). The urinary biochemical parameters(24 h-UP, mAlb, BLD), serum IgA1, Gd-IgA1, IL-17 and Th17/CD4^+ and Th17/Treg in the Hp-infection group were higher than that in the non-Hp-infection group(P<0.05), whereas the Treg/CD4^+ was significantly lower than that in the non-Hp infection group(P<0.05). The 2-year renal survival rate in the Hp-infection group(90.70%) was significantly lower than that in the non-Hp-infection group(98.40%)(P<0.05). CONCLUSION Hp infection can participate in the progression of IgA nephropathy and change the prognosis status by changing the balance of Th17/Treg and abnormal glycosylation of IgA1. It is necessary to actively prevent and control Hp infection in clinical practice so as to improve the status of diagnosis and treatment of IgA nephropathy.