体质量指数与特发性膜性肾病临床病理特征的关系

The relationship between body mass index and clinicopathologic characteristics of idiopathic membranous nephropathy

目的探讨体质量指数(BMI)对特发性膜性肾病(IMN)患者临床病理特征的影响。方法261例IMN患者根据BMI分为正常组(66例)、超重组(105例)和肥胖组(90例)。比较3组患者临床及肾脏病理学资料,采用Pearson或Spearman相关分析BMI与临床病理指标之间的相关性,多重线性回归分析肾小球滤过率(eGFR)的影响因素,二元Logistic回归分析间质纤维化(IF)、肾小管萎缩(TA)、肾小球硬化(GS)和系膜细胞增殖(MCP)的影响因素。结果与正常组相比,超重组糖尿病患病率、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)升高;肥胖组高血压患病率、血红蛋白(HGB)、尿酸(UA)、LDL-C、TG、24 h尿蛋白(UTP)和血清补体3(C3)升高,高密度脂蛋白胆固醇(HDLC)降低(P<0.05)。与超重组比较,肥胖组高血压患病率、UA、TG和血清C3升高(P<0.05)。肥胖和超重组肾小球基底膜(GBM)厚度高于正常组,肥胖组GS和IF比例高于正常组(P<0.05)。BMI与高血压、TG、LDL-C、血清C3、UTP、GS、IF、MCP、C3系膜区沉积呈正相关,与HDL-C呈负相关(P<0.05)。多重线性回归分析显示,年龄、血尿素氮(BUN)、抗磷脂酶A2受体抗体(anti-PLA2R)、UTP、TA是eGFR的独立影响因素。二元Logistic回归分析显示,BMI、年龄、UTP和血肌酐(Scr)升高为IF的独立危险因素;年龄、Scr和UA升高为TA的独立危险因素;BMI升高和eGFR下降为GS的独立危险因素;BMI升高为MCP的独立危险因素。3组IMN患者的治疗方案差异无统计学意义。结论肥胖会导致IMN患者多项临床及病理指标加重。

Objective To investigate the effect of body mass index(BMI)on the clinicopathological characteristics of patients with idiopathic membranous nephropathy(IMN).Methods A total of 261 patients with IMN were divided into the normal group(66 cases),the overweight group(105 cases)and the obese group(90 cases)according to BMI.Clinical and renal pathological data of patients were compared between the three groups.The correlation between BMI and clinicopathological indexes was analyzed by Pearson or Spearman′s correlation.The influencing factors of estimated glomerular filtration rate(eGFR)were analyzed by multiple linear regression,and the influencing factors of interstitial fibrosis(IF),tubular atrophy(TA),glomerulosclerosis(GS)and mesangial cell proliferation(MCP)were analyzed by binary Logistic regression.Results Compared with the normal group,the prevalence of diabetes mellitus,triglycerides(TG)and low-density lipoprotein cholesterol(LDL-C)were elevated in the overweight group.The prevalence of hypertension,hemoglobin(HGB),uric acid(UA),LDL-C,TG,24-h urinary protein(UTP)and serum complement 3(C3)were elevated,and high-density lipoprotein cholesterol(HDL-C)was decreased in the obese group(P<0.05).The prevalence of hypertension,UA,TG and serum C3 were elevated in the obese group compared to the overweight group(P<0.05).The glomerular basement membrane(GBM)thickness was higher in the obese group and the overweight group than that in the normal group,and the proportion of GS and IF was higher in the obese group than that in the normal group(P<0.05).BMI was positively correlated with hypertension,TG,LDL-C,serum C3,UTP,GS,IF,MCP and deposition in the mesangial region of C3,and negatively correlated with HDL-C(P<0.05).Multiple linear regression analysis showed that age,blood urea nitrogen(BUN),anti-phospholipase A2 receptor antibody(anti-PLA2R),UTP and TA were independent risk factors of eGFR.Binary Logistic regression analysis showed that elevated BMI,age,UTP and serum creatinine(Scr)were independent risk factors for IF.Age,Scr and elevated UA were independent risk factors for TA.Elevated BMI and decreased eGFR were independent risk factors for GS.Elevated BMI was an independent risk factor for MCP.There was no significant difference in the treatment protocol of IMN patients between the three groups.Conclusion Obesity can exacerbate multiple clinical and pathological outcomes in IMN patients.