关键词: 肾小球肾炎, IgA, 残余胆固醇, 肾小管, 间质纤维化

Abstract:

Objective To investigate the association between remnant cholesterol （RC） and clinicopathological parameters in patients with IgA nephropathy （IgAN）， and to assess the clinical significance of RC in the progression and management of IgAN. Methods A total of 366 patients with a biopsy?proven diagnosis of IgAN were consecutively enrolled in this retrospective study. Clinical and pathological data were systematically collected， and RC was calculated. Participants were stratified into two groups according to the median RC value. Baseline characteristics were compared between these groups. The association between RC and the presence of tubular atrophy/interstitial fibrosis （T1/2 lesions） in IgAN patients was evaluated using binary logistic regression， restricted cubic spline （RCS） analysis， receiver operating characteristic （ROC） curve analysis， and subgroup analyses. Results In this study， the high?RC group exhibited significantly higher levels of body weight， body mass index （BMI）， systolic blood pressure （SBP）， diastolic blood pressure （DBP）， triglycerides （TG）， total cholesterol （TC）， non?high?density lipoprotein cholesterol （non?HDL?C）， uric acid （UA）， complement 3 （C3）， and 24?hour urinary protein， as well as lower levels of albumin （ALB）， estimated glomerular filtration rate （eGFR）， and high?density lipoprotein cholesterol （HDL?C）， compared to the low?RC group. Patients with T1/2 lesions showed elevated levels of SBP， DBP， TC， non?HDL?C， UA， 24?hour urinary protein， and RC， along with reduced levels of hemoglobin （Hb）， ALB， and eGFR， relative to those with T0 lesions. Multivariate logistic regression analysis indicated that increased RC and decreased eGFR were independent risk factors for the presence of T1/2 lesions in patients with IgAN （P < 0.05）. RCS analysis revealed a linear association between RC and the likelihood of T1/2 lesions （non?linearity P = 0.343）. The area under the receiver operating characteristic curve （AUC） for a predictive model incorporating RC， Hb， UA， and eGFR was 0.833， indicating good discriminative ability. Subgroup analyses consistently demonstrated a significant association between RC and the risk of T1/2 lesions， with no statistically significant interactions observed across subgroups （all P > 0.05）. Conclusion RC can reflect the severity of both clinical and pathological manifestations in patients with IgAN， making RC monitoring a potentially valuable tool for assessing disease progression in clinical practice.

Key words: glomerulonephritis, immunoglobulin A, remnant cholesterol, kidney tubules, interstitial fibrosis