血清25-羟基维生素D3水平在IgA血管炎肾炎患儿中临床病理及预后意义

Clinicopathological significance and prognostic value of serum 25-hydroxyvitamin D3 level in children with IgA vasculitis nephritis

摘要:

目的 分析血清25-羟基维生素D₃［25-hydroxyvitamin D₃, 25-(OH)D₃］水平在IgA血管炎肾炎（immunoglobulin A vasculitis nephritis, IgAVN）患儿的临床病理特征及预后中的意义。方法 回顾性分析2015年6月—2020年6月在安徽医科大学附属宿州医院和南京大学医学院附属金陵医院儿科完善肾活检的IgAVN患儿的临床资料。根据25-(OH)D₃水平将患儿分为正常组和低下组，收集并比较两组患儿的临床病理特征及随访资料。结果 共纳入了359例IgAVN患儿，与正常组（62例）相比，低下组（297例）患儿便血比例、肉眼血尿比例、血清肌酐、血尿素氮、尿视黄醇蛋白、尿N-乙酰-β-D-氨基葡萄糖苷酶、尿蛋白定量、肾活检至尿蛋白转阴时间等指标均较高（P<0.05），估算的肾小球滤过率和白蛋白水平较低（P<0.05）。低下组肾脏病理显示肾小管间质损伤、新月体比例、肾小球节段硬化和肾间质炎症细胞浸润的发生比例高于正常组（P<0.05）。生存分析显示，低下组患儿的肾脏累积生存率较低（P<0.05）。多因素Cox回归分析显示血清25-(OH)D₃低下是IgAVN预后不良的独立危险因素（P<0.05）。结论 血清25-(OH)D₃水平低下的IgAVN患儿的临床病理表现相对严重。血清25-(OH)D₃水平低下是儿童IgAVN预后不良的独立危险因素。

Abstract:

Objective To study the significance of serum 25-hydroxyvitamin D₃ [25-(OH)D₃] level in the clinicopathological characteristics and prognosis of children with immunoglobulin A vasculitis nephritis (IgAVN).Methods A retrospective analysis was conducted on the clinical data of children with IgAVN who underwent renal biopsy at Suzhou Hospital Affiliated to Anhui Medical University and Jinling Hospital of the Medical School of Nanjing University from June 2015 to June 2020. Based on serum 25-(OH)D₃ level, the patients were divided into a normal group and a lower group. The clinicopathological characteristics and follow-up data of the two groups were collected and compared.Results A total of 359 children with IgAVN were included. Compared to the normal group (62 cases), the lower group (297 cases) exhibited higher incidences of hematochezia and gross hematuria, higher levels of serum creatinine, blood urea nitrogen, urinary retinol protein, urinary N-acetyl-β-D-glucosaminidase, and quantitative urinary protein, and a longer duration from renal biopsy to urinary protein becoming negative, as well as lower estimated glomerular filtration rate and albumin level (P<0.05). Renal pathology in the lower group showed a higher occurrence of tubular interstitial injury, crescent formation, segmental sclerosis in glomeruli, and inflammatory cell infiltration in the renal interstitium compared to the normal group (P<0.05). Survival analysis indicated that the cumulative renal survival rate was lower in the lower group (P<0.05). Multivariate Cox regression analysis revealed that low serum 25-(OH)D₃ level is an independent risk factor for poor prognosis in children with IgAVN.Conclusions Children with IgAVN and low serum 25-(OH)D₃ level have relatively severe clinicopathological manifestations. Low serum 25-(OH)D₃ level is an independent risk factor for poor prognosis in children with IgAVN.