Influence of acute infection before onset on the levels of immunoglobulins and complements in serum and renal tissue of adult patients with IgA nephropathy

doi:10.3877/cma.j.issn.1674-0785.2022.02.009

Abstract

Abstract:

Objective

To analyze the influence of acute infection before onset on the levels of immunoglobulins (Igs) and complements (Cs) in serum and renal tissue of adult patients with IgA nephropathy, to provide evidence for the role of infection factors in the occurrence and progression of IgA nephropathy.

Methods

Sixty adult IgA nephropathy patients with acute infection before onset from October 2014 to February 2018 at the Department of Rheumatic Nephropathy of Haikou People's Hospital were selected as a study group, and 60 adult IgA nephropathy patients without acute infection before onset were selected as a control group. The general data, the levels of serum Igs and Cs, and the deposition intensity of Igs and Cs in renal tissue were compared between the two groups.

Results

In the study group, 43 cases (71.67%) had acute upper respiratory tract infection before onset, 11 (18.33%) had acute pulmonary infection before onset, and 6 (10%) had acute digestive tract infection before onset. The 24-hour urinary protein quantity, the levels of serum IgA and IgG of the patients in the study group were (2.82±1.33) g/d, (2.87±1.06) g/L, and (8.14±3.04) g/L, respectively, which were higher than those of the control group (P＜0.05). The deposition intensity of IgA, IgG, C3, C4, and C1q in the renal tissue of the study group were significantly higher than those of the control group (P＜0.05).

Conclusion

The proteinuria symptoms of IgA nephropathy patients with a history of acute infection before onset are more serious, the levels of serum Ig and the deposition intensity of Igs and Cs in renal tissue are higher, and the prognosis may be worse. Clinicians should give full attention and timely and effective intervention to these patients.

Key words: Immunoglobulin A nephropathy, Infection, Immunoglobulin, Complement

Kailang Chen, Song Lin, Dongming Wu, Rukai Su, Yuanchun Chen. Influence of acute infection before onset on the levels of immunoglobulins and complements in serum and renal tissue of adult patients with IgA nephropathy[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(02): 157-163.

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Figures/Tables 4

项目	研究组（60例）	对照组（60例）	t/χ²值	P值
性别［例（%）］			0.307	0.580
男	36（60.00）	33（55.00）
女	24（40.00）	27（45.00）
年龄（岁， $x ¯$ ±s）	36.89±12.26	37.08±12.72	-0.083	0.918
糖尿病［例（%）］	7（11.67）	9（15.00）	0.288	0.591
高血压［例（%）］	8（13.33）	7（11.67）	0.076	0.783
SBP（mmHg， $x ¯$ ±s）	134.25±7.16	133.56±7.27	0.524	0.477
DBP（mmHg， $x ¯$ ±s）	85.16±6.28	84.72±6.63	0.373	0.629
HB（g/l， $x ¯$ ±s）	135.57±20.16	136.29±22.47	-0.185	0.817
ALB（g/l， $x ¯$ ±s）	38.92±6.12	39.72±5.67	-0.743	0.258
ALT（U/l， $x ¯$ ±s）	21.35±15.49	20.68±14.92	0.241	0.761
GOT（U/l， $x ¯$ ±s）	20.77±16.12	20.65±14.15	0.043	0.958
FBG（mmol/l， $x ¯$ ±s）	5.37±0.88	5.32±0.92	0.304	0.700
TG（mmol/l， $x ¯$ ±s）	2.26±1.45	2.23±1.87	0.098	0.905
TC（mmol/l， $x ¯$ ±s）	5.49±1.92	5.27±1.55	0.691	0.312
HDL-C（mmol/l， $x ¯$ ±s）	1.17±0.42	1.21±0.39	-0.541	0.452
LDL-C（mmol/l， $x ¯$ ±s）	3.05±1.24	2.97±1.33	0.341	0.660
BUN（mmol/l， $x ¯$ ±s）	6.55±3.68	6.41±3.76	0.206	0.795
BUA（μmol/l， $x ¯$ ±s）	376.64±105.68	371.14±109.06	0.281	0.719
Scr（μmol/l， $x ¯$ ±s）	92.78±15.27	92.24±16.03	0.189	0.815
Cys C（mg/L， $x ¯$ ±s）	1.08±0.26	1.05±0.25	0.644	0.461
24 h尿蛋白定量（g/d， $x ¯$ ±s）	2.82±1.33	2.02±1.19	3.472	0.002
eGFR（ml/min/1.73m²， $x ¯$ ±s）	88.94±38.81	87.46±38.81	0.209	0.793
牛津分型［例（%）］
M0/M1	27（45.00）/33（55.00）	29（48.33）/31（51.67）	0.134	0.714
E0/E1	35（58.33）/25（41.67）	37（61.67）/23（38.33）	0.139	0.709
S0/S1	31（51.67）/29（48.33）	32（53.33）/28（46.67）	0.033	0.855
T0/T1/T2	31（51.67）/20（33.33）/9（15.00）	33（55.00）/19（31.67）/8（13.33）	0.147	0.929

项目	研究组（60例）	对照组（60例）	t/χ²值	P值
性别［例（%）］			0.307	0.580
男	36（60.00）	33（55.00）
女	24（40.00）	27（45.00）
年龄（岁， $x ¯$ ±s）	36.89±12.26	37.08±12.72	-0.083	0.918
糖尿病［例（%）］	7（11.67）	9（15.00）	0.288	0.591
高血压［例（%）］	8（13.33）	7（11.67）	0.076	0.783
SBP（mmHg， $x ¯$ ±s）	134.25±7.16	133.56±7.27	0.524	0.477
DBP（mmHg， $x ¯$ ±s）	85.16±6.28	84.72±6.63	0.373	0.629
HB（g/l， $x ¯$ ±s）	135.57±20.16	136.29±22.47	-0.185	0.817
ALB（g/l， $x ¯$ ±s）	38.92±6.12	39.72±5.67	-0.743	0.258
ALT（U/l， $x ¯$ ±s）	21.35±15.49	20.68±14.92	0.241	0.761
GOT（U/l， $x ¯$ ±s）	20.77±16.12	20.65±14.15	0.043	0.958
FBG（mmol/l， $x ¯$ ±s）	5.37±0.88	5.32±0.92	0.304	0.700
TG（mmol/l， $x ¯$ ±s）	2.26±1.45	2.23±1.87	0.098	0.905
TC（mmol/l， $x ¯$ ±s）	5.49±1.92	5.27±1.55	0.691	0.312
HDL-C（mmol/l， $x ¯$ ±s）	1.17±0.42	1.21±0.39	-0.541	0.452
LDL-C（mmol/l， $x ¯$ ±s）	3.05±1.24	2.97±1.33	0.341	0.660
BUN（mmol/l， $x ¯$ ±s）	6.55±3.68	6.41±3.76	0.206	0.795
BUA（μmol/l， $x ¯$ ±s）	376.64±105.68	371.14±109.06	0.281	0.719
Scr（μmol/l， $x ¯$ ±s）	92.78±15.27	92.24±16.03	0.189	0.815
Cys C（mg/L， $x ¯$ ±s）	1.08±0.26	1.05±0.25	0.644	0.461
24 h尿蛋白定量（g/d， $x ¯$ ±s）	2.82±1.33	2.02±1.19	3.472	0.002
eGFR（ml/min/1.73m²， $x ¯$ ±s）	88.94±38.81	87.46±38.81	0.209	0.793
牛津分型［例（%）］
M0/M1	27（45.00）/33（55.00）	29（48.33）/31（51.67）	0.134	0.714
E0/E1	35（58.33）/25（41.67）	37（61.67）/23（38.33）	0.139	0.709
S0/S1	31（51.67）/29（48.33）	32（53.33）/28（46.67）	0.033	0.855
T0/T1/T2	31（51.67）/20（33.33）/9（15.00）	33（55.00）/19（31.67）/8（13.33）	0.147	0.929

组别	IgA	IgG	IgM	C3	C4
研究组（60例）	2.87±1.06	8.14±3.04	1.38±0.56	1.28±0.32	0.38±0.15
对照组（60例）	2.06±0.97	5.65±2.68	1.41±0.61	1.25±0.35	0.34±0.13
t值	4.367	4.759	-0.281	0.49	1.561
P值	＜0.001	＜0.001	0.719	0.511	0.072

指标	研究组（60例）	对照组（60例）	Z值	P值
IgA			3.021	0.003
+	6（10.00）	15（25.00）
++	35（58.33）	37（61.67）
+++	19（31.67）	8（13.33）
IgG			8.593	＜0.001
-	48（80.00）	55（91.67）
+	7（11.67）	3（5.00）
++	5（8.33）	2（3.33）
IgM			1.847	0.065
-	29（48.33）	32（53.33）
+	23（38.33）	19（31.67）
++	8（13.33）	9（15.00）
C3			6.775	＜0.001
-	15（25.00）	26（43.33）
+	21（35.00）	25（41.67）
++	23（38.33）	6（10.00）
+++	1（1.67）	3（5.00）
C4			10.183	＜0.001
-	51（85.00）	59（98.33）
+	6（10.00）	1（1.67）
++	3（5.00）	0（0.00）
C1q			8.915	＜0.001
-	52（86.67）	55（91.67）
+	4（6.67）	5（8.33）
++	4（6.67）	0（0.00）

References 28

1	Gutiérrez E, Carvaca-Fontán F, Luzardo L, et al. A personalized update on IgA nephropathy: a new vision and new future challenges [J]. Nephron, 2020, 144(11): 555-571.
2	Hassler JR. IgA nephropathy: a brief review [J]. Semin Diagn Pathol, 2020, 37(3): 143-147.
3	Zheng Y, Wang Y, Liu S, et al. Potential blood pressure goals in IgA nephropathy: prevalence, awareness, and treatment rates in chronic kidney disease among patients with hypertension in China (PATRIOTIC) study [J]. Kidney Blood Press Res, 2018, 43(6): 1786-1795.
4	Moran SM, Cattran DC. Recent advances in risk prediction, therapeutics and pathogenesis of IgA nephropathy [J]. Minerva Med, 2019, 110(5): 439-449.
5	Tortajada A, Gutierrez E, Pickering MC, et al. The role of complement in IgA nephropathy [J]. Mol Immunol, 2019, 114: 123-132.
6	闫冰娟, 苏晓乐, 王利华, 等. IgA肾病进展危险因素评估 [J]. 中国药物与临床, 2020, 20(24): 4091-4093.
7	Moriyama T. Clinical and histological features and therapeutic strategies for IgA nephropathy [J]. Clin Exp Nephrol, 2019, 23(9): 1089-1099.
8	Selvaskandan H, Cheung CK, Muto M, et al. New strategies and perspectives on managing IgA nephropathy [J]. Clin Exp Nephrol, 2019, 23(5): 577-588.
9	Thompson A, Carroll K, Inker LA, et al. Proteinuria reduction as a surrogate end point in trials of IgA nephropathy [J]. Clin J Am Soc Nephrol, 2019, 14(3): 469-481.
10	Mantoo MR, Tripathy SK, Phulware RH, et al. Juvenile dermatomyositis with IgA nephropathy: case-based review [J]. Rheumatol Int, 2019, 39(3): 577-581.
11	Isakova T, Nickolas TL, Denburg M, et al. KDOQI US commentary on the 2017 KDIGO clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD) [J]. Am J Kidney Dis, 2017, 70(6): 737-751.
12	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 急性上呼吸道感染基层诊疗指南(2018年) [J]. 中华全科医师杂志, 2019, 18(5): 422-426.
13	Rose MA, Barker M, Liese J, et al. Guidelines for the management of community acquired pneumonia in children and adolescents (pediatric community acquired pneumonia, pCAP)-issued under the responsibility of the German society for pediatric infectious diseases (DGPI) and the German society for pediatric pulmonology (GPP) [J]. Pneumologie, 2020, 74(8): 515-544.
14	缪晓辉, 冉陆, 张文宏, 等. 成人急性感染性腹泻诊疗专家共识 [J]. 中华消化杂志, 2013, 33(12): 793-802.
15	American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019 [J]. Diabetes Care, 2019, 42(Suppl 1): S13-S28.
16	Unger T, Borghi C, Charchar F, et al. 2020 international society of hypertension global hypertension practice guidelines [J]. Hypertension, 2020, 75(6): 1334-1357.
17	Trimarchi H, Barratt J, Cattran DC, et al. Oxford classification of IgA nephropathy 2016: an update from the IgA nephropathy classification working group [J]. Kidney Int, 2017, 91(5): 1014-1021.
18	Tomino Y. How to treat patients with chronic kidney disease: with special focus on IgA nephropathy [J]. Nephrology (Carlton), 2018, Suppl 4: 76-79.
19	田秀娟, 黄晨. IgA肾病免疫炎症发病机制研究进展 [J]. 中华肾脏病杂志, 2020, 27(5): 400-405.
20	Medjeral-Thomas NR, O'Shaughnessy MM. Complement in IgA nephropathy: the role of complement in the pathogenesis, diagnosis, and future management of IgA nephropathy [J]. Adv Chronic Kidney Dis, 2020, 27(2): 111-119.
21	裴改琴, 秦嫒雅, 王思清, 等. 血清IgA/C3和病理C3沉积对IgA肾病患者临床预后的影响 [J]. 中华医学杂志, 2020, 100(30): 2372-2377.
22	符庆瑛, 刘扬, 汪卫华, 等. IgA肾病患儿感染与血压及免疫指标的关联性 [J]. 临床儿科杂志, 2020, 38(6): 410-413.
23	Barratt J, Tang SCW. Treatment of IgA nephropathy: evolution over half a century [J]. Semin Nephrol, 2018, 38(5): 531-540.
24	Coppo R. The gut-renal connection in IgA nephropathy [J]. Semin Nephrol, 2018, 38(5): 504-512.
25	唐余燕, 贺海东, 孙蔚倩, 等. CD4^+T淋巴细胞在IgA肾病中致病作用机制研究 [J]. 临床肾脏病杂志, 2020, 20(2): 147-153.
26	Bai L, Li H, Li J, et al. Immunosuppressive effect of artemisinin and hydroxychloroquine combination therapy on IgA nephropathy via regulating the differentiation of CD4+T cell subsets in rats [J]. Int Immunopharmacol, 2019, 70: 313-323.
27	吴秀花, 陈贞敏, 吴秀丽, 等. 幽门螺杆菌感染对IgA肾病患者24 h-UP、mAlb、BLD、IgA1及肾脏生存率的影响 [J]. 中华医院感染学杂志, 2020, 30(16): 2430-2433.
28	查汗·索林格, 桑晓红, 李素华, 等. 慢性牙周炎与IgA肾病相关性研究进展 [J]. 中华实用诊断与治疗杂志, 2019, 33(2): 184-186.

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