目的 探究残余胆固醇（RC）与IgA肾病（IgAN）患者临床病理指标的相关性，并评估RC在IgAN中的临床意义。 方法 于承德医学院附属医院纳入经肾穿刺活检确诊的366例IgAN患者作为研究对象，回顾性收集患者的临床和病理资料，并计算RC。依据RC中位数将患者分为低RC组与高RC组，比较两组基线资料的差异。通过二元logistic回归分析、限制性立方样条（RCS）分析、ROC曲线分析及亚组分析研究RC与IgAN患者T病变之间的关联。 结果 与低RC组相比，高RC组患者体质量、体质量指数（BMI）、收缩压（SBP）、舒张压（DBP）、甘油三酯（TG）、总胆固醇（TC）、非高密度脂蛋白胆固醇（non-HDL-C）、尿酸（UA）、C₃及24 h尿蛋白水平更高（P < 0.05），而白蛋白（ALB）、估算肾小球滤过率（eGFR）、高密度脂蛋白胆固醇（HDL-C）水平更低（P < 0.05）。与T0病变组患者相比，T1/2病变组患者SBP、DBP、TC、non-HDL-C、UA、24 h尿蛋白及RC水平更高（P < 0.05），血红蛋白（Hb）、ALB、eGFR水平更低（P < 0.05）。二元多因素logistic回归分析显示，RC、UA水平升高及Hb、eGFR水平降低是IgAN患者T1/2病变的独立危险因素（P < 0.05）。RCS分析显示，RC与IgAN 患者T1/2病变呈线性关联（非线性P = 0.483）。由RC、UA、HB联合eGFR建立IgAN患者T1/2病变预测模型的曲线下面积（AUC）为0.833。亚组分析结果显示，RC与IgAN患者T1/2病变风险存在显著相关，且RC与性别、eGFR、24 h尿蛋白定量间不存在交互作用（P_交互 > 0.05）。 结论 RC水平可反映IgAN患者临床和病理损害的严重程度，监测RC水平或有助于判断疾病进展情况。

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.