IgG4相关肾病患者血清IgG4表达水平与肾功能、微炎症状态的相关性分析

祁娇; 许珊珊; 段晓星; 王海欣; 孟彦; 赵建荣

doi:10.3969/j.issn.1671-2390.2024.01.003

IgG4相关肾病患者血清IgG4表达水平与肾功能、微炎症状态的相关性分析

Correlation analysis of serum IgG4 expression level with renal function and micro inflammatory status in patients with IgG4-related nephropathy

摘要

摘要:
目的分析IgG4相关肾病患者血清IgG4水平与肾功能、微炎症状态的相关性。
方法选取内蒙古医科大学附属医院2018年1月至2022年8月收治的60例IgG4相关肾病患者记为研究组，另基于倾向性匹配法按照1∶1的比例选取60名健康志愿者记为对照组。2组受试者均检测血清IgG4水平、肾功能指标血肌酐（serum creatinine，Scr）、血尿素氮（blood urea nitrogen，BUN）、估算肾小球滤过率（estimated glomerular filtration rate，eGFR）、24 h尿蛋白定量（24 h urinary total protein quantification，24 hUTP）和微炎症状态白细胞介素（interleukin，IL）6、超敏C反应蛋白（high-sensitivity C-reactive protein，hs-CRP）、肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）。比较2组受试者血清IgG4、肾功能及微炎症状态指标；Pearson法分析研究组中患者血清IgG4水平与肾功能、微炎症状态的相关性；Logistic回归分析确定患者肾功能不全的危险因素。
结果研究组血清IgG4（67.75 ± 18.63）mg/L比（6.54 ± 1.19）mg/L、Scr（182.75 ± 32.69）μmol/L比（75.40 ± 15.61）μmol/L、BUN（10.15 ± 2.90）mmol/L比（5.28 ± 1.04）mmol/L、IL-6（5.18 ± 1.04）ng/L比（0.40 ± 0.05）ng/L、hs-CRP（24.69 ± 5.06）mg/L比（4.58 ± 0.92）mg/L、TNF-α（6.85 ± 1.79）μg/L比（1.18 ± 0.21）μg/L和24 hUTP（182.75 ± 32.69）mg比（89.75 ± 12.36）mg水平均高于对照组（P＜0.05），eGFR低于对照组（90.10 ± 9.87）mL·min⁻¹·（1.73 m²）⁻¹比（104.36 ± 20.15）mL·min⁻¹·（1.73 m²）⁻¹，P＜0.05；研究组血清IgG4水平与Scr、BUN、24 hUTP、IL-6、hs-CRP、TNF-α均呈正相关（r = 0.586、0.543、0.575、0.602、0.596、0.574，P＜0.05），与eGFR呈负相关（r = −0.602，P = 0.001）；研究组肾功能不全发生率为78.33%，病程、合并高血压、血清IgG4水平均是肾功能不全发生的影响因素（OR = 3.190、2.401、3.466，P＜0.05）。
结论 IgG4相关肾病患者血清IgG4升高，且与肾功能、微炎症状态均有关，病程、合并高血压、血清IgG4水平均是肾功能不全发生的影响因素。

Abstract:
Objective To explore the correlation between serum level of immunoglobulin G4 （IgG4）, renal function and micro inflammatory status in patients with IgG4-related nephropathy.
Methods From January 2018 to August 2022, 60 patients hsopiatlized with IgG4-related nephropathy were selected as study group while another 60 healthy volunteers chosen as control group in 1∶1 ratio based upon propensity matching. Serum level of IgG4, renal function parameters of serum creatinine （Scr）, blood urea nitrogen （BUN）, estimated glomerular filtration rate （eGFR） and 24 h urinary total protein quantification （24 hUTP） and micro inflammatory status including interleukin-6 （IL-6）, high-sensitivity C-reactive protein （hs-CRP） and tumor necrosis factor-α （TNF-α） were detected in both groups. Serum level of IgG4, renal function and micro inflammatory status were compared between two groups. Pearson’s method was employed for examining the correlation between serum level of IgG4, renal function and micro inflammatory status in study group. Logistic regression analysis was performed for determining the risk factors for renal insufficiency.
Results Serum level of IgG4 （67.75 ± 18.63） mg/L vs （6.54 ± 1.19） mg/L, Scr （182.75 ± 32.69） μmol/L vs （75.40 ± 15.61） μmol/L, BUN （10.15 ± 2.90） mmol/L vs （5.28 ± 1.04） mmol/L, IL-6 （5.18 ± 1.04） ng/L vs （0.40 ± 0.05） ng/L, hs-CRP （24.69 ± 5.06） mg/L vs （4.58 ± 0.92） mg/L, TNF-α （6.85 ± 1.79） μg/L vs （1.18 ± 0.21） μg/L and 24 hUTP （182.75 ± 32.69） mg vs （89.75 ± 12.36） mg were higher in study group than those in control group （P＜0.05）; eGFR was lower than that in control group （90.10 ± 9.87） mL·min⁻¹·（1.73 m²）⁻¹ vs （104.36 ± 20.15） mL·min⁻¹·（1.73 m²）⁻¹ （P＜0.05）. Serum level of IgG4 was correlated positively with Scr, BUN, 24 hUTP, IL-6, hs-CRP and TNF-α （r = 0.586, 0.543, 0.575, 0.602, 0.596, 0.574, P＜0.05） and negatively with eGFR in study group （r = −0.602, P＜0.05）. The incidence of renal insufficiency was 78.33% in study group. Course of disease, hypertension and serum level of IgG4 were the influencing factors of renal insufficiency （OR = 3.190, 2.401, 3.466, P＜0.05）.
Conclusions An elevated serum level of IgG4 in patients with IgG4-related nephropathy is correlated with renal function and micro inflammatory status. And course of disease, concurrent hypertension and serum IgG4 level are the influencing factors for renal insufficiency.

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