营养水平与IgA肾病患者临床及病理特征相关性的研究

杜艳彬; 杜艳玲; 李欢; 袁祖君

doi:10.3969/j.issn.1671-2390.2025.04.004

营养水平与IgA肾病患者临床及病理特征相关性的研究

Study on the correlation of nutritional status with clinical and pathological characteristics of patients with IgA nephropathy

摘要

摘要: 目的探究血清总蛋白、白蛋白、预后营养指数（prognostic nutritional index，PNI）与IgA肾病（IgA nephropathy，IgAN）临床及病理特征的相关性，评估这些营养指标对IgAN患者疾病严重程度的影响。方法选取自2019年1月1日至2024年4月1日于南充市中心医院肾脏内科就诊的218例IgAN患者。收集患者的基线资料、血液生化结果、营养和肾功能指标，同时基于经皮肾镜活检结果依照牛津分类法进行病理学评估。根据PNI、血清总蛋白和白蛋白的中位数分为高、低营养水平组，比较不同营养水平组的临床及病理特征。结果高、低总蛋白组，高、低白蛋白组，高、低PNI组中，随着营养水平的提高，反映肾功能的相关指标出现显著变化。与低总蛋白组患者相比，高总蛋白组患者血肌酐［（112.41 ±21.86）μmol/L比（93.54 ±20.44）μmol/L］，胱抑素C［1.14（0.81，1.22）mg/L比0.92（0.77，1.16）mg/L］下降（P<0.05），估算肾小球滤过率（estimated glomerular filtration rate，eGFR）［85.26（74.34，98.78）mL·min^-1·（1.73 m²）^-1比111.34（92.56，118.92）mL·min^-1·（1.73 m²）^-1］升高（P=0.005）。与低PNI组患者相比，高PNI组患者血肌酐［（111.33 ±17.66）μmol/L比（88.42 ±15.34）μmol/L］，胱抑素C［1.13（0.88，1.24）mg/L比0.86（0.61，0.99）mg/L］下降（P<0.05），eGFR［64.27（49.37，88.53）mL·min^-1·（1.73 m²）^-1比104.35（89.25，128.81）mL·min^-1·（1.73 m²）^-1］升高（P=0.001）。此外，在各组患者中，营养水平越高，对应的IgAN病理类型预后越好，即肾脏损伤的程度越小（P<0.05）。经逻辑回归分析，仅PNI对IgAN患者是否存在较重的系膜细胞增生有显著的统计学影响，PNI越高，系膜细胞增生的程度越轻（OR=0.559，95%CI：0.339~0.932，P=0.016）。结论血清总蛋白、白蛋白、PNI等营养指标与IgAN患者的临床病理特征相关。PNI可作为辅助判断IgAN患者病理严重程度、病理分型及相应治疗决策的参考指标，有助于提高患者的治疗效果和预后。

Abstract: Objective To explore the correlation of serum total protein， albumin， and prognostic nutritional index （PNI） with the clinical and pathological characteristics of IgA nephropathy （IgAN）， and to evaluate the impact of these nutritional indicators on the severity of IgAN.Methods A total of 218 IgAN patients who were treated at Nephrology Department of Nanchong Central Hospital from January 1， 2019， to April 1， 2024 were included in this study. Baseline data， blood biochemistry results， nutritional and renal function indicators were collected from the patients. Pathological evaluations were performed according to the Oxford classification based on the results of percutaneous renal biopsy. Patients were divided into high/low nutritional status groups based on the median of PNI， and serum total protein， and albumin levels， and the clinical and pathological characteristics of different groups were compared.Results In the high and low total protein groups， high and low albumin groups， and high and low PNI groups， significant changes in renal function-related indicators were observed as nutritional levels increased. Compared to the low total protein group， the high total protein group had significantly lower serum creatinine［（112.41 ±21.86）μmol/L vs （93.54 ±20.44）μmol/L］， and cystatin C ［1.14（0.81，1.22）mg/L vs 0.92（0.77，1.16）mg/L］（P<0.05）， and a higher estimated glomerular filtration rate （eGFR）［85.26（74.34，98.78）mL·min^-1·（1.73 m²）^-1 vs 111.34（92.56，118.92）mL·min^-1·（1.73 m²）^-1］（P = 0.005）. Compared to the low PNI group， the high PNI group had lower serum creatinine［（111.33 ±17.66）μmol/L vs （88.42 ±15.34）μmol/L］， cystatin C［1.13（0.88，1.24）mg/L vs 0.86（0.61，0.99）mg/L］（P<0.05）， and a higher eGFR［64.27（49.37，88.53）mL·min^-1·（1.73 m²）^-1 vs 104.35（89.25，128.81）mL·min^-1·（1.73 m²）^-1］（P = 0.001）. Moreover， in all groups， higher nutritional levels corresponded to better prognosis of IgAN pathological types， indicating less severe renal injury （P<0.05）. Logistic regression analysis showed that only PNI had a significant statistical impact on whether IgAN patients had severe mesangial proliferation of glomerular capillaries. A higher PNI was associated with less severe mesangial proliferation （OR = 0.559， 95% CI： 0.339-0.932， P = 0.016）.Conclusion Serum albumin， total protein， PNI， and other nutritional indicators are correlated with the clinical and pathological characteristics of IgAN patients. PNI can be used as an auxiliary indicator to assess the severity of pathology， pathological classification， and corresponding treatment decisions， thus improving treatment outcomes and prognosis in IgAN patients.

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