血清缺氧诱导因子1α与IgA肾病肾间质病变及其预后关系的研究

Relationship between serum hypoxia-inducible factor-1αand renal interstitial disease and its prognosis in IgA nephropathy

目的探讨血清缺氧诱导因子1α(hypoxia inducible factor-1α,HIF-1α)与原发性IgA肾病(IgA nephropathy,IgAN)肾间质病变及其预后的关系。方法回顾性分析宁夏回族自治区人民医院(宁夏医科大学附属自治区人民医院)2017年8月至2021年8月明确诊断为IgAN的142例患者临床资料,依据血清HIF-1α水平,以肾间质病变的严重程度分为两组,肾小管间质病变比例≤25%为肾间质病变轻组,>25%为肾间质病变重组。比较两组患者的指标差异,并将两组差异有统计学意义的指标进行多因素分析;将血清HIF-1α与肾病进展的危险因素指标进行相关分析。结果两组患者性别、24 h尿蛋白定量、体重指数、血清白蛋白、低密度脂蛋白胆固醇、三酰甘油、高血压等资料比较,差异均无统计学意义(P>0.05);肾间质病变重组患者年龄[(44.45±9.65)岁比(38.36±11.09)岁]、血肌酐[(116.28±44.75)μmol/L比(84.82±42.06)μmol/L]、血尿酸[(389.03±104.57)μmol/L比(353.39±90.01)μmol/L]、血清HIF-1α[(213.53±68.86)pg/L比(141.13±60.61)pg/L]高于肾间质病变轻组(P<0.05),而血红蛋白[(124.11±28.24)g/L比(134.18±22.07)g/L]低于肾间质病变轻组(P<0.05)。多因素分析提示血清HIF^(-1)α与年龄是肾间质病变的危险因素。血清HIF-1α与血肌酐呈正相关(r=0.465,P<0.05),与24 h尿蛋白定量呈正相关(r=-0.420,P<0.05),与血尿酸呈正相关(r=-0.217,P<0.05),与血红蛋白呈负相关(r=-0.284,P=0.003)。血清HIF-1α的受试者工作特征曲线分析提示曲线下面积为0.760(P<0.001),血清HIF-1α诊断肾功能异常的临界点为201.50 pg/L,尤登指数为0.44。结论血清HIF-1α与IgAN肾间质病变相关,同时与IgAN进展的危险因素有相关性,临床上可以关注血清HIF-1α水平以判断IgAN的预后。

Objective To explore the relationship between serum hypoxia inducible factor-1α(HIF-1α)and renal interstitial lesions in primary IgA nephropathy(IgAN).Methods From August 2017 to August 2021,retrospective analysis was performed for 142 IgAN patients.The relevant clinical data were collected and serum HIF-1αlevel was detected.They were divided into two groups according to the severity of renal interstitial lesions.Proportion of renal tubulointerstitial lesions≤25%was mild group while>25%severe group.Inter-group differences in various parameters were examined by multiple fac-tors.Correlations between serum HIF-1αand risk factors of kidney disease progression were analyzed.No statistically significant inter-group differences existed in gender,24 h urine protein quantification,body mass index(BMI),serum albumin,low-density lipoprotein cholesterol,triglycerides or hypertension(P>0.05).As compared with mild group,age[(44.45±9.65)year vs(38.36±11.09)year],blood creatinine[(116.28±44.75)μmol/L vs(84.82±42.06)μmol/L],blood uric acid[(389.03±104.57)μmol/L vs(353.39±90.01)μmol/L],serum HIF-1α[(213.53±68.86)pg/L vs(141.13±60.61)pg/L]were higher(P<0.05)while hemoglobin[(124.11±28.24)g/L vs(134.18±22.07)g/L]was lower in severe group(P<0.05).Multivariate analysis revealed that serum HIF-1αand age were risk factors for renal interstitial disease.Serum HIF-1αwas correlated positively with serum creatinine(r=0.465,P<0.05),24 h urinary protein quantity(r=-0.420,P<0.05)and serum uric acid(r=-0.217,P<0.05)and negatively with hemoglobin(r=-0.284,P=0.003).ROC curve analysis of serum HIF-1α indicated that area under the curve was 0.760(P<0.001),critical point of serum HIF-1αfor diagnosing renal dysfunction was 201.50 pg/L and Uden index was 0.44.Conclusions Serum HIF-1α is associated with renal interstitial disease of IgAN and risk factors for IgAN progression.It is clinically feasible to track serum HIF-1α level to judge the prog-nosis of IgAN.