尿蛋白定量联合eGFR在评估移植肾IgA肾病病理损伤程度中的应用

A combination of 24-h urinary protein and eGFR for evaluating the histopathological injury of IgA nephropathy in renal allografts

目的探讨24h尿蛋白定量联合估算肾小球滤过率(eGFR)在评估移植肾IgA肾病病理损伤程度中的应用。方法回顾性分析2004年7月至2018年6月间于中山大学附属第一医院行活体肾移植术后穿刺活检确诊移植肾IgA肾病受者共115例,基于Lee病理分级标准,分析相关临床指标在评估移植肾IgA肾病病理损伤程度中的应用价值。结果组间对照显示,不同Lee分级者在发病时间、血清白蛋白、24 h尿蛋白定量和eGRF降低上差异有统计学意义(P<0.01);Logistic回归分析显示尿蛋白定量(风险比率1.6每增加1 g,95%CI 1.2~2.3)及eGRF降低[风险比率1.1,每降低1 ml/(min·1.73m^2),95%CI 1.0~1.1]是移植肾重度损伤(Lee分级Ⅳ~Ⅴ级)的独立预测因子;拟合ROC曲线显示上述两项指标在诊断移植肾重度损伤中具有较高价值(曲线下面积=0.83),结合临床实践,选取尿蛋白定量1.3 g,eGRF下降6.0 ml/(min·1.73m^2)为最佳诊断界值,此界值敏感度95.5%,特异度59.1%。结论24 h尿蛋白定量联合eGFR有助于评估移植肾IgA肾病的病理损伤程度,对于重度损伤者具有较高的诊断价值。

Objective To explore the diagnostic value of 24-h urinary protein plus estimated glomerular filtration rate(eGFR)for evaluating the histopathological injury of IgA nephropathy(IgAN)in renal allografts.Methods From July 2004 to June 2018,a series of 115 biopsies for IgAN were performed in renal allografts after living-donor transplantation.Based upon the Lee's classification scheme,clinical parameters were retrospectively analyzed for different degrees of histopathological injury.Results Comparison among Lee's grades I-V revealed that onset time,serum albumin,24-h urinary protein and decline of eGFR were significantly different(P<0.01).Logistic multivariate analysis indicated that 24-h urinary protein(HR 1.6 for 1-g increase,95%CI 1.2-2.3)and decline of eGFR(HR 1.1 for 1-ml(min·1.73m^2)decline,95%CI 1.0-1.1)were independent predictors of severe injury(IV-V).ROC curve fitted by the above two parameters had a value of 0.83.In conjunctions with clinical experiences,1.3 g of 24-h urinary protein and 6.0 ml(min·1.73m^2)decline of eGFR were selected as an ideal cutoff.And the sensitivity and specificity were 95.5%and 59.1%respectively.Conclusions A combination of 24-h urinary protein and eGFR may successfully evaluate the histopathological injury of IgA nephropathy in renal allografts,especially severe type.