PDF(Pubmed)
Abstract：
The significance of glomerular IgM deposit intensity in IgA Nephropathy (IgAN) remained ambiguous and requires further research. Patients with biopsy-proven IgAN in our hospital from January 2018 to May 2023 were recruited into this retrospective single-center study. Patients who presented with positive IgM deposit were included in IgM + cohort while patients with negative IgM deposit were included in IgM- cohort. Of the IgM+, patients whose IF intensity of IgM deposits exceeded 1+ formed IgM-H cohort while patients whose IF intensity of IgM deposits was equal to 1+ consisted IgM-L cohort. Pairwise comparisons were performed among these cohorts to determine clinical disparities, following the propensity score matching process. Among 982 IgAN patients, 539 patients presented with positive IgM deposit. The Kaplan-Meier analysis showed that the IgM deposit did not contribute adversely to the outcomes (eGFR decreased from the baseline ≥ 50% continuously or reached end-stage renal disease). However, the Cox regression analysis showed that increased intensity of IgM deposit was an independent risk factor (p = 0.03) in IgM+. The IgM-H exhibited more pronounced segmental glomerulosclerosis (p = 0.02) than the IgM-L, which may also be associated more directly with higher urine protein levels (p = 0.02). Moreover, our generalized linear mixed model demonstrated a remarkably higher urine albumin/creatinine ratio (p < 0.01) and serum creatinine (p = 0.04) levels as well as lower serum albumin (p < 0.01) level in IgM-H persistently during the 5-year follow-up. This study concluded that increased intensity of glomerular IgM deposits may contribute adversely to clinicopathologic presentation and outcome in those IgM + patients.
摘要：
肾小球IgM沉积强度在IgA肾病（IgAN）中的意义仍然不明确，需要进一步研究。2018年1月至2023年5月在我们医院接受活检证实的IgAN患者被纳入这项回顾性单中心研究。IgM沉积阳性的患者被纳入IgM+队列，而IgM沉积阴性的患者被纳入IgM-队列。IgM+，IgM沉积的IF强度超过1+的患者构成IgM-H队列,而IgM沉积的IF强度等于1+的患者构成IgM-L队列.在这些队列中进行成对比较以确定临床差异，遵循倾向评分匹配过程。在982例IgAN患者中，539例患者呈现IgM沉积阳性。Kaplan-Meier分析显示，IgM沉积物对结果没有不利影响（eGFR从基线持续下降≥50％或达到终末期肾病）。然而,Cox回归分析显示IgM沉积强度增加是IgM+的独立危险因素(p=0.03).IgM-H比IgM-L表现出更明显的节段性肾小球硬化（p=0.02），这也可能与更高的尿蛋白水平更直接相关（p=0.02）。此外，我们的广义线性混合模型显示,在5年随访期间,IgM-H患者的尿白蛋白/肌酐比值(p<0.01)和血清肌酐水平(p=0.04)显著较高,血清白蛋白水平(p<0.01)较低.这项研究得出结论，肾小球IgM沉积强度的增加可能对这些IgM患者的临床病理表现和预后产生不利影响。
