Abstract：
OBJECTIVE: To investigate the correlations of total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL) with various clinical indicators and pathological features of patients with IgA nephropathy (IgAN).
METHODS: Patients diagnosed with IgAN were included and divided into low and high TBIL/DBIL/IBIL groups. Correlation analysis was performed to assess the relationships between the bilirubin indices and other clinical and pathological variables. Logistic regression was applied to identify the independent risk factors of mesangial cell proliferation (corresponding to M1 in the Oxford classification of IgAN).
RESULTS: Totally 192 patients with IgAN were included, and the patient clinical indicators were compared between the different bilirubin subgroups. Compared to the groups with higher TBIL, DBIL, and IBIL levels, groups with lower values of these bilirubin indices exhibited a higher 24-hour urine protein (24hUP) concentration but a lower proportion of males as well as reduced total protein, albumin, haemoglobin, and glutamic-pyruvic transaminase levels (p < 0.05). Moreover, the low-DBIL group displayed higher total cholesterol, triglyceride, and low-density lipoprotein (LDL) concentrations (p < 0.05) than those in the high DBIL group. Spearman analysis further revealed that TBIL, DBIL, and IBIL were negatively correlated with 24hUP and positively correlated with haemoglobin, total protein, and albumin (p < 0.05). Additionally, DBIL exhibited negative correlations with total cholesterol, triglyceride, and LDL (p < 0.05). From a pathological perspective, M1 incidence was higher in the low TBIL and IBIL groups (both p < 0.05). Furthermore, the high IBIL group showed a lower occurrence of cellular/fibrocellular crescents (C1 (in at least one glomerulus) and C2 (in >25% of glomeruli) in the Oxford classification, p < 0.05). Lastly, the multivariate regression model suggested that IBIL was an independent protective factor for M1 (odds ratio = 0.563, 95% confidence interval = 0.344-0.921, p = 0.022).
CONCLUSIONS: Patients with IgAN accompanied by low values of bilirubin indices exhibit worsened disease-related clinical indicators (24hUP, total protein, albumin, and haemoglobin levels). Reduced TBIL and IBIL concentrations are indicative of severe renal pathology, with IBIL being a protective factor against M1.
METHODS: Patients diagnosed with IgAN were included and divided into low and high TBIL/DBIL/IBIL groups. Correlation analysis was performed to assess the relationships between the bilirubin indices and other clinical and pathological variables. Logistic regression was applied to identify the independent risk factors of mesangial cell proliferation (corresponding to M1 in the Oxford classification of IgAN).
RESULTS: Totally 192 patients with IgAN were included, and the patient clinical indicators were compared between the different bilirubin subgroups. Compared to the groups with higher TBIL, DBIL, and IBIL levels, groups with lower values of these bilirubin indices exhibited a higher 24-hour urine protein (24hUP) concentration but a lower proportion of males as well as reduced total protein, albumin, haemoglobin, and glutamic-pyruvic transaminase levels (p < 0.05). Moreover, the low-DBIL group displayed higher total cholesterol, triglyceride, and low-density lipoprotein (LDL) concentrations (p < 0.05) than those in the high DBIL group. Spearman analysis further revealed that TBIL, DBIL, and IBIL were negatively correlated with 24hUP and positively correlated with haemoglobin, total protein, and albumin (p < 0.05). Additionally, DBIL exhibited negative correlations with total cholesterol, triglyceride, and LDL (p < 0.05). From a pathological perspective, M1 incidence was higher in the low TBIL and IBIL groups (both p < 0.05). Furthermore, the high IBIL group showed a lower occurrence of cellular/fibrocellular crescents (C1 (in at least one glomerulus) and C2 (in >25% of glomeruli) in the Oxford classification, p < 0.05). Lastly, the multivariate regression model suggested that IBIL was an independent protective factor for M1 (odds ratio = 0.563, 95% confidence interval = 0.344-0.921, p = 0.022).
CONCLUSIONS: Patients with IgAN accompanied by low values of bilirubin indices exhibit worsened disease-related clinical indicators (24hUP, total protein, albumin, and haemoglobin levels). Reduced TBIL and IBIL concentrations are indicative of severe renal pathology, with IBIL being a protective factor against M1.
摘要：
目的：探讨总胆红素(TBIL)与直接胆红素（DBIL），间接胆红素(IBIL)与IgA肾病(IgAN)患者的各项临床指标及病理特征有关。
方法：将诊断为IgAN的患者分为TBIL/DBIL/IBIL低和高两组。进行相关性分析以评估胆红素指数与其他临床和病理变量之间的关系。应用Logistic回归分析确定肾小球系膜细胞增殖的独立危险因素(对应IgAN牛津分类中的M1)。
结果：共纳入192例IgAN患者，并对不同胆红素亚组的患者临床指标进行比较。与TBIL较高的组相比，DBIL,和IBIL水平，这些胆红素指数较低值的组表现出更高的24小时尿蛋白（24hUP）浓度，但男性比例较低以及总蛋白减少，白蛋白,血红蛋白，和谷氨酸-丙酮酸转氨酶水平(p<0.05)。此外，低DBIL组显示出更高的总胆固醇，甘油三酯，而低密度脂蛋白(LDL)浓度高于高DBIL组(p<0.05)。斯皮尔曼分析进一步显示，TBIL，DBIL,IBIL与24hUP呈负相关，与血红蛋白呈正相关，总蛋白质，和白蛋白(p<0.05)。此外,DBIL与总胆固醇呈负相关，甘油三酯，和LDL(p<0.05)。从病理学的角度来看,低TBIL和IBIL组M1发生率较高(均p<0.05)。此外，在牛津分类中，高IBIL组的细胞/纤维细胞新月体发生率较低（C1（至少一个肾小球）和C2（>25％的肾小球），p<0.05)。最后,多元回归模型提示IBIL是M1的独立保护因素(比值比=0.563,95%置信区间=0.344~0.921,p=0.022).
结论：伴有胆红素指数低值的IgAN患者表现出与疾病相关的临床指标恶化（24hUP，总蛋白质，白蛋白,和血红蛋白水平)。TBIL和IBIL浓度降低表明严重的肾脏病理，IBIL是针对M1的保护因子。
方法：将诊断为IgAN的患者分为TBIL/DBIL/IBIL低和高两组。进行相关性分析以评估胆红素指数与其他临床和病理变量之间的关系。应用Logistic回归分析确定肾小球系膜细胞增殖的独立危险因素(对应IgAN牛津分类中的M1)。
结果：共纳入192例IgAN患者，并对不同胆红素亚组的患者临床指标进行比较。与TBIL较高的组相比，DBIL,和IBIL水平，这些胆红素指数较低值的组表现出更高的24小时尿蛋白（24hUP）浓度，但男性比例较低以及总蛋白减少，白蛋白,血红蛋白，和谷氨酸-丙酮酸转氨酶水平(p<0.05)。此外，低DBIL组显示出更高的总胆固醇，甘油三酯，而低密度脂蛋白(LDL)浓度高于高DBIL组(p<0.05)。斯皮尔曼分析进一步显示，TBIL，DBIL,IBIL与24hUP呈负相关，与血红蛋白呈正相关，总蛋白质，和白蛋白(p<0.05)。此外,DBIL与总胆固醇呈负相关，甘油三酯，和LDL(p<0.05)。从病理学的角度来看,低TBIL和IBIL组M1发生率较高(均p<0.05)。此外，在牛津分类中，高IBIL组的细胞/纤维细胞新月体发生率较低（C1（至少一个肾小球）和C2（>25％的肾小球），p<0.05)。最后,多元回归模型提示IBIL是M1的独立保护因素(比值比=0.563,95%置信区间=0.344~0.921,p=0.022).
结论：伴有胆红素指数低值的IgAN患者表现出与疾病相关的临床指标恶化（24hUP，总蛋白质，白蛋白,和血红蛋白水平)。TBIL和IBIL浓度降低表明严重的肾脏病理，IBIL是针对M1的保护因子。
