IgA肾病患者的淋巴细胞亚群与临床病理特征及肾脏预后的关系

doi:10.3969/j.issn.1006-5725.2025.03.007

Abstract

Abstract:

Objective To examine the association between lymphocyte subsets and renal clinicopathological characteristics as well as prognosis in patients with IgA nephropathy （IgAN）. Methods The retrospective analysis included general clinical data and pathological examination results of IgAN patients diagnosed by renal biopsy at the Fourth Hospital of Hebei Medical University from January 2018 to January 2022. Correlation tests were conducted to examine the relationship between lymphocyte subsets and other significant clinicopathological parameters. The optimal cut?off value of CD4⁺ T determined using the Youden index， and patients were grouped accordingly. Kaplan?Meier survival curves and Cox regression analyses were employed to compare the low and high CD4⁺ T lymphocyte groups among IgAN patients， identifying factors influencing renal function progression. The endpoint event was defined as a decrease in estimated glomerular filtration rate （eGFR） of ≥ 30% from baseline， progression to end?stage renal disease （ESRD）［eGFR < 15 mL/（min·1.73 m²） or initiation of renal replacement therapy］， or all?cause mortality. Results Low CD4⁺ T lymphocytes were significantly positively correlated with blood IgA levels and the proportion of glomerular crescents in IgAN patients （all P < 0.05）. This study included a total of 53 IgAN patients， divided into two groups based on CD4⁺ T lymphocyte counts： 20 patients in the low CD4⁺ T lymphocyte group and 33 patients in the high CD4⁺ T lymphocyte group. In the low CD4⁺ T lymphocyte group， there was a higher proportion of males and a lower proportion of glomerular crescents （P < 0.05）. Kaplan?Meier survival analysis revealed that patients with low CD4⁺ lymphocytes had a significantly lower cumulative renal survival rate （Log?Rank test χ² = 4.188， P = 0.041）. Cox regression analysis indicated that low CD4⁺ lymphocytes were an independent risk factor for the progression of renal function decline in IgAN patients （HR = 2.614， 95% CI： 1.006 ~ 6.788， P = 0.048）. Conclusions Patients with higher levels of CD4⁺ T lymphocytes exhibit a lower risk of adverse renal outcomes. In contrast， patients with IgA nephropathy and low CD4⁺ T lymphocyte counts tend to have poorer renal survival rates.

Key words: IgA nephropathy, CD₄⁺T lymphocytes, prognosis

CLC Number:

R692.3

Shenglei ZHANG,Ruicong TIAN,Jingjing JIN,Fan LU,Meijuan CHENG,Yaling BAI,Jinsheng. XU. To study the relationship between lymphocyte subsets and renal clinicopathological features and prognosis in patients with IgA nephropathy[J]. The Journal of Practical Medicine, 2025, 41(3): 352-357.

Figures/Tables 5

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Tab.2

Fig.2

Tab.3

References 26

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变量	相关系数	P值
年龄	-0.135	0.337
性别（男）	0.136	0.233
BMI	-0.071	0.612
高血压	-0.180	0.116
糖尿病	-0.136	0.233
冠心病	-0.172	0.133
SBP（> 140 mmHg）	-0.225	0.105
DBP（> 90 mmHg）	-0.197	0.157
eGFR	-0.070	0.619
血IgA	0.404	0.004
肌酐	-0.059	0.675
24 h尿蛋白	-0.102	0.479
尿红细胞	-0.039	0.784
尿素	-0.038	0.788
尿酸	0.097	0.488
白蛋白	0.243	0.079
M1	-0.007	0.948
S1	-0.116	0.311
E1	-0.002	0.848
T1/2	-0.003	0.978
C1/2	0.281	0.014

变量	高CD4⁺ T淋巴细胞组（n = 33）	低CD4⁺ T淋巴细胞组（n = 20）	P值
年龄（> 45岁）	13（39.4）	10（50）	0.450
性别			0.038
男	17（51.5）	16（80.0）
女	16（48.3）	4（20.0）
BMI（x ± s）/（kg/m²）	24.967 ± 3.867	25.140 ± 4.404	0.881
高血压	13（39.4）	11（55）	0.269
糖尿病	1（3.0）	2（10.0）	0.652
冠心病	1（3.0）	2（10.0）	0.652
SBP（> 140 mmHg）	8（24.2）	9（45）	0.117
DBP（> 90 mmHg）	8（24.2）	9（45）	0.117
eGFR（x ± s）/［mL/min·1.73 m²］	77.923 ± 32.161	73.6135 ± 42.768	0.700
血IgA（x ± s）/（g/L）	3.848 ± 1.611	3.033 ± 1.094	0.063
肌酐［M（P₂₅，P₇₅）］/（μmol/L）	95.10（64.45，139.35）	117.70（67.00，720.00）	0.244
尿素［M（P₂₅，P₇₅）］/（mmol/L）	5.90（4.70，7.45）	7.05（4.025，13.225）	0.521
尿酸（x ± s）/（μmol/L）	413.518 ± 112.049	401.19 ± 128.070	0.715
24 h尿蛋白［M（P₂₅，P₇₅）］/（mg/24 h）	1603.00（710.00，2082.00）	2414.00（720.00，4008.00）	0.342
尿红细胞（x ± s）/μL	18.00（4.35，62.00）	14.50（4.50，109.89）	0.748
白蛋白［M（P₂₅，P₇₅）］/（g/L）	39.424 ± 3.941	36.455 ± 6.318	0.069
M1	32（97.0）	20（100.0）	1.000
S1	23（69.7）	17（85.0）	0.355
E1	9（27.3）	5（25.0）	0.856
T1/2	19（57.6）	13（65.0）	0.592
C1/2	16（48.5）	3（15.0）	0.014
治疗方式			0.723
支持治疗	23（69.7）	13（65）
免疫抑制剂治疗	10（30.3）	7（35）

变量	单因素
变量	HR（95%CI）	P值
低CD4⁺ T	2.614（1.006～6.788）	0.048
性别（男）	2.040（0.662～6.288）	0.215
年龄（> 45岁）	1.353（0.534～3.428）	0.524
高血压	2.378（0.891～6.343）	0.084
BMI	0.976（0.881～1.080）	0.635
SBP（> 140 mmHg）	0.927（0.342～2.511）	0.882
DBP（> 90 mmHg）	0.518（0.176～1.526）	0.233
肌酐	1.005（1.003～1.008）	< 0.001
24 h尿蛋白	1.000（1.000～1.000）	0.064
尿红细胞	1.000（1.000～1.001）	0.084
白蛋白	0.898（0.828～0.974）	0.009
血IgA	0.678（0.419～1.099）	0.115
M1	0.046（0.000～40 602.360）	0.660
S1	0.616（0.177～2.148）	0.447
E1	1.262（0.470～3.388）	0.645
T1/2	0.021（0.000～1.068）	0.054
C1/2	1.594（0.624～4.072）	0.329
治疗方式	2.785（1.071～7.241）	0.036

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To study the relationship between lymphocyte subsets and renal clinicopathological features and prognosis in patients with IgA nephropathy

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