小儿IgAN肾小管间质病变程度与血清IgA、IgA/C3比值及尿液MCP-1水平的相关性

Correlation of the degree of tubulointerstitial lesions with serum IgA,IgA/C3 ratio,and urine MCP-1 level in children with IgA nephropathy

目的探究小儿IgA肾病(IgAN)肾小管间质病变与血清免疫球蛋白(Ig)A、IgA/补体C3比值及尿液核细胞趋化蛋白-1(MCP-1)水平的关系。方法回顾性分析2020年4月至2023年4月南阳市中心医院收治的60例IgAN患儿的临床资料,根据肾小管间质病变与否分为对照组(无病变)6例和观察组(有病变)54例,同时根据观察组患者的活检病理结果对肾小管间质损害程度进行分级,其中A组(轻度病变)25例、B组(中度病变)19例和C组(重度病变)10例,比较三组患儿的肝功能相关指标及血清IgA、IgA/C3比值和尿液MCP-1水平,采用Spearman相关性分析血清IgA、IgA/C3比值、尿液MCP-1水平与小儿IgA肾病肾小管间质病变的关系。结果观察组患者的N-乙酰-β-D-葡萄糖苷酶(NAG)和β_(2)微球蛋白(β_(2)-MG)分别为(51.09±21.15)U/L、(667.40±224.89)μg/L,明显高于对照组的(13.15±5.42)U/L、(215.86±81.65)μg/L,差异均有统计学意义(P<0.05);观察组患者的肌酐清除率为(65.82±16.05)mL/min,明显低于对照组的(90.15±11.23)m L/min,差异有统计学意义(P<0.05);随着肾小管间质病变程度的加重,NAG、β_(2)-MG水平随之升高,肌酐清除率随之降低,差异均有统计学意义(P<0.05);对照组患儿的IgA和IgA/C3比值分别为(2.85±1.66)g/L、3.06±1.55,明显低于观察组的(5.85±2.29)g/L、6.56±2.16,差异均有统计学意义(P<0.05);观察组患者的MCP-1水平为(1.02±0.19)ng/L,明显低于对照组的(1.97±0.57),差异有统计学意义(P<0.05);随着肾小管间质病变程度的加重,MCP-1水平随之升高,差异有统计学意义(P<0.05);经Spearman相关性分析结果显示,IgAN患儿肾小管间质病变与NAG、β_(2)-MG、IgA、IgA/C3比值、MCP-1水平呈正相关(P<0.05),与肌酐清除率呈负相关(P<0.05)。结论IgA、IgA/C3比值、MCP-1水平与IgAN患儿肾小管间质病变呈正相关,临床可通过检测IgA、IgA/C3比值、MCP-1水平,以评估IgAN病情和肾小管间质损伤程度。

Objective To investigate the relationship of tubulointerstitial lesions with serum immunoglobulin A(IgA),IgA/complement C3 ratio,and urine monocyte chemoattractant protein-1(MCP-1)level in children with IgA nephropathy(IgAN).Methods The clinical data of 60 children with IgAN who were admitted to Nanyang Central Hospital from April 2020 to April 2023 were analyzed retrospectively.According to the presence or absence of tubulointerstitial lesion,the children were divided into the control group(without lesion,6 cases)and the observation group(with lesions,54 cases).Based on the pathological results,children with tubulointerstitial lesions were divided into group A(mild lesions,25 cases),group B(moderate lesions,19 cases),and group C(severe lesions,10 cases).Liver function-related indicators,serum IgA,IgA/C3 ratio,and urine MCP-1 levels in all children were tested.Spearman correlation analysis was conducted to discuss the correlation between serum IgA,IgA/C3 ratio,urine MCP-1 level and tubulointerstitial lesions in children with IgAN.Results The levels of N-acetyl-beta-D-glucosaminidase(NAG)andβ_(2) microglobulin(β_(2)-MG)in the observation group were(51.09±21.15)U/L and(667.40±224.89)μg/L,significantly higher than(13.15±5.42)U/L and(215.86±81.65)μg/L in the control group(P<0.05).The creatinine clearance rate in the observation group was(65.82±16.05)mL/min,significantly lower than(90.15±11.23)mL/min in the control group(P<0.05).As tubulointerstitial lesions got worse,the levels of NAG andβ_(2)-MG increased and creatinine clearance rate decreased,with statistically significant differences(P<0.05).IgA and IgA/C3 ratio in the control group were(2.85±1.66)g/L and 3.06±1.55,significantly lower than(5.85±2.29)g/L and(6.56±2.16)in the observation group(P<0.05).MCP-1 level in the observation group was(1.02±0.19)ng/L,significantly lower than(1.97±0.57)ng/L in the control group(P<0.05).As renal tubulointerstitial lesions got worse,MCP-1 level increased(P<0.05).Spearman correlation analysis showed that tubulointerstitial lesions in children with IgAN were positively correlated with NAG,β_(2)-MG,IgA,IgA/C3 ratio,and MCP-1 level(P<0.05),but negatively correlated with creatinine clearance rate(P<0.05).Conclusion IgA,IgA/C3 ratio,and MCP-1 level are positively correlated with tubulointerstitial lesions in children with IgAN.Detecting IgA,IgA/C3 ratio and MCP-1 level can help to evaluate the severity of IgAN and tubulointerstitial lesions.