Effects of smoking on renal function and pathological changes in idiopathic membranous nephropathy (IMN) patients
-
摘要: 目的 探讨吸烟在特发性膜性肾病（idiopathic membranous nephropathy，IMN）患者肾功能减退及病理变化中的作用。方法 纳入吉林大学第二医院肾病内科2018年4月至2019年8月经皮肾穿刺活检病理确诊为IMN的患者共60例，收集IMN患者的临床资料、实验室检查资料及病理资料，并调查患者的吸烟状况，分析IMN患者吸烟状态与估算肾小球滤过率（estimated glomerular filtration rate，eGFR）及病理指标的关系。结果 单因素相关性分析显示，eGFR与吸烟量呈负相关（r=-0.26，P<0.05），肾间质血管总分与吸烟量呈正相关（rs=0.69，P<0.01）。吸烟者肾小管间质纤维化及血管病变更重，多因素二元Logistic回归分析发现吸烟增加IMN患者肾间质纤维化（OR=6.42，P<0.05）、血管壁增厚（OR=4.71，P<0.05）及血管玻璃样变（OR=7.43，P<0.05）的风险。结论 吸烟对IMN患者肾功能具有一定的损害作用，是IMN患者肾小管间质纤维化、血管壁增厚及血管玻璃样变的独立危险因素。Abstract: Objective To investigate the role of smoking in renal dysfunction and pathological changes in patients with idiopathic membranous nephropathy (IMN). Methods A total of 60 patients with pathological diagnosis of IMN by renal puncture biopsy in the Second Hospital of Jilin University from April 2018 to August 2019 were included. We collected clinical data, laboratory data and pathologic data of these patients, estimated glomerular filtration rate (eGFR), investigated IMN patients with smoking status, and analyzed the smoking status of IMN patients and the relationship between eGFR and pathological indicators. Results Single-factor correlation analysis showed that eGFR was negatively correlated with smoking (r=-0.26, P<0.05), and the total renal interstitial vascular score was positively correlated with smoking (rs=0.69, P<0.01). Renal tubulointerstitial fibrosis and vascular disease were more severe in smokers, multivariate binary Logistic regression analysis revealed that smoking increased the risk of renal interstitial fibrosis (OR=6.42,P<0.05),vascular wall thickening (OR=4.71,P<0.05) and vitreous degeneration of blood vessels(OR=7.43,P<0.05) in IMN patients.Conclusions Smoking has a certain damage effect on renal function of IMN patients, and is an independent risk factor for renal tubulointerstitial fibrosis, vascular wall thickening and vitreous degeneration of blood vessels in IMN patients.
-
-
[1] Lai WL, Yeh TH, Chen PM, et al. Membranous nephropathy:a review on the pathogenesis, diagnosis, and treatment[J]. J Formos Med Assoc, 2015, 114(2):102-111. DOI: 10.1016/j.jfma.2014.11.002.
[2] Mortensen ME, Wong LY, Osterloh JD. Smoking status and urine cadmium above levels associated with subclinical renal effects in US adults without chronic kidney disease[J]. Int J Hyg Environ Health, 2011, 214(4):305-310. DOI: 10.1016/j.ijheh.2011.03.004.
[3] Panhwar AH, Kazi TG, Afridi HI, et al. Correlation of cadmium and aluminum in blood samples of kidney disorder patients with drinking water and tobacco smoking:related health risk[J]. Environ Geochem Health, 2016, 38(1):265-274. DOI: 10.1007/s10653-015-9715-y.
[4] Wilk A, Kalisińska E, Kosik-Bogacka DI, et al. Cadmium, lead and mercury concentrations in pathologically altered human kidneys[J]. Environ Geochem Health, 2017, 39(4):889-899. DOI: 10.1007/s10653-016-9860-y.
[5] Ejerblad E, Fored CM, Lindblad P, et al. Association between smoking and chronic renal failure in a nationwide population-based case-control study[J]. J Am Soc Nephrol, 2004, 15(8):2178-2185. DOI: 10.1097/01.ASN.0000135048.35659.10.
[6] Garrett BE, Dube SR, Trosclair A, et al. Cigarette smoking-United States, 1965-2008[J]. MMWR Suppl, 2011, 60(1):109-113.
[7] Katafuchi R, Kiyoshi Y, Oh Y, et al. Glomerular score as a prognosticator in IgA nephropathy:its usefulness and limitation[J]. Clin Nephrol, 1998, 49(1):1-8.
[8] Li LS, Liu ZH. Epidemiologic data of renal diseases from a single unit in China:analysis based on 13, 519 renal biopsies[J]. Kidney Int, 2004, 66(3):920-923. DOI: 10.1111/j.1523-1755.2004.00837.x.
[9] 吴成态,丁秀,王小琴.特发性膜性肾病发病机制的研究进展[J].临床肾脏病杂志, 2018, 18(8):505-508. DOI: 10.3969/j.issn.1671-2390.2018.08.013. [10] Beck LH Jr, Bonegio RG, Lambeau G, et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy[J]. N Engl J Med, 2009, 361(1):11-21. DOI: 10.1056/NEJMoa0810457.
[11] Han QQ, Wang SS, Zhang JL, et al. The association between cigarette smoking and diabetic nephropathy in Chinese male patients[J]. Acta Diabetol, 2018, 55(11):1131-1141. DOI: 10.1007/s00592-018-1197-9.
[12] Yamamoto R, Nagasawa Y, Shoji T, et al. Cigarette smoking and progression of IgA nephropathy[J]. Am J Kidney Dis, 2010, 56(2):313-324. DOI: 10.1053/j.ajkd.2010.02.351.
[13] Yamaguchi M, Ando M, Yamamoto R, et al. Smoking is a risk factor for the progression of idiopathic membranous nephropathy[J]. PLoS One, 2014, 9(6):e100835. DOI: 10.1371/journal.pone.0100835.
[14] Xia J, Wang L, Ma ZH, et al. Cigarette smoking and chronic kidney disease in the general population:a systematic review and meta-analysis of prospective cohort studies[J]. Nephrol Dial Transplant, 2017, 32(3):475-487. DOI: 10.1093/ndt/gfw452.
[15] Arany I, Grifoni S, Clark JS, et al. Chronic nicotine exposure exacerbates acute renal ischemic injury[J]. Am J Physiol Renal Physiol, 2011, 301(1):F125-F133. DOI: 10.1152/ajprenal.00041.2011.
[16] Chen CM, Chou HC, Huang LT. Maternal nicotine exposure during gestation and lactation induces kidney injury and fibrosis in rat offspring[J]. Pediatr Res, 2015, 77(1-1):56-63. DOI: 10.1038/pr.2014.148.
[17] Formanek P, Salisbury-Afshar E, Afshar M. Helping patients with ESRD and earlier stages of CKD to quit smoking[J]. Am J Kidney Dis, 2018, 72(2):255-266. DOI: 10.1053/j.ajkd.2018.01.057.
-
期刊类型引用(3)
1. 蔡忠林，陈晨. 终末期肾病血液透析患者发生动静脉内瘘失功的影响因素分析. 现代医学与健康研究电子杂志. 2025(06): 130-133 . 
百度学术
2. 赵文娟，夏世国. 血清中HMGB1表达水平与慢性肾-心综合征病情严重程度及预后的关系分析. 中国中西医结合肾病杂志. 2023(06): 527-529 . 百度学术
3. 贺志花，王利华. 膜性肾病发病机制研究新进展. 临床肾脏病杂志. 2022(05): 423-428 . 本站查看
其他类型引用(9)
计量
- 文章访问数: 397
- HTML全文浏览量: 1
- PDF下载量: 414
- 被引次数: 12
下载:
.png)