Analysis of clinical features and prognostic factors of IgA nephropathy complicated with depression

doi:10.3969/j.issn.1004-583X.2023.06.005

Abstract

Abstract:

Objective To analyze the clinical features and prognostic factors of IgA nephropathy complicated with depression. Methods A total of 100 patients with IgA nephropathy treated in the Ningbo Yinzhou No.2 Hospital from January 2019 to December 2019 were selected as the study objects. According to the absence or presence of depression, they were divided into control group (50 cases without depression) and observation group (50 cases with depression). The general data, laboratory indexes and pathological classification were analyzed and compared between groups. Kaplan-Meier method was used to evaluate the overall survival (OS), and Logistics regression was used to analyze the prognostic factors. Resultss There were statistically significant differences in the course of disease, working status, monthly household income per capita, glomerular filtration rate (eGFR), hemoglobin, serum albumin, blood uric acid (SUA) and C3 levels, as well as the degree of inflammatory cell infiltration and vascular injury between the two groups ( P <0.01). Compared with the control group, patients in the observation group had a longer course of disease, a higher proportion of non-employees and lower family per capita monthly income ( P <0.05). Compared with the control group, patients in the observation group had significantly lower estimated glomerular filtration rate (eGFR), hemoglobin and serum albumin, significantly higher serum uric acid (SUA) and C3, and significantly higher degree of inflammatory cell infiltration and vascular injury ( P <0.05). Logistic regression analysis showed that the course of disease, family per capita monthly income, eGFR, hemoglobin, serum albumin, degree of inflammatory cell infiltration and degree of vascular injury were independent risk factors for IgA nephropathy patients complicated with depression ( P <0.05). At the end of the 3-year follow-up, endpoint events were recorded in 12 patients (doubling the serum creatinine level and/or progressing to the end-stage renal disease [ESRD] and/or receiving renal replacement therapy and/or death was considered as a composite endpoint event), including 9 in the observation group and 3 in the control group. The 1-year and 3-year OS in the observation group was 94.00% and 82.00%, respectively, and that in the control group was 98.00% and 94.00%, respectively. There was a significant difference in the 3-year OS between groups ( P =0.034).Conclusion The independent risk factors for IgA nephropathy complicated with depression include the course of disease, family per capita monthly income, eGFR, hemoglobin, serum albumin, the degree of inflammatory cell infiltration and vascular injury, and the survival time of IgA nephropathy patients complicated with depression significantly decreases.

Key words: glomerulonephritis, IgA, depression, prognosis, pathological classification, clinical features

CLC Number:

R692.31

Gao Qinyu, Bao Beiyan, Jin Yan, Zhao Yu. Analysis of clinical features and prognostic factors of IgA nephropathy complicated with depression[J]. Clinical Focus, 2023, 38(6): 510-515.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.06.005

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I6/510

Figures/Tables 5

Tab. 1 Comparison of general data between the two groups ( n)

组别	例数	年龄 (岁)		性别			病程			文化程度				婚姻状态		工作状态
组别	例数	年龄 (岁)		男		女	<2年	2~4年	≥5年	小学及初中		中专及高中	大专及以上	已婚	未婚	在职	非在职
观察组	50	38.18±8.61		25		25	12	19	19	11		23	16	43	7	38	12
对照组	50	36.98±9.87		27		23	28	15	7	5		28	17	42	8	21	29
$t$ /χ²值		-0.674		0.160			10.078			0.196				0.078		11.947
$P$ 值		0.440		0.689			0.005			0.558				0.779		0.001
组别	家庭人均月收入(元)						吸烟史	饮酒史	BMI(kg/m²)			合并心血管疾病	合并脑血管疾病	合并高血压		合并糖尿病
组别	4000~8000		>8000		≤4000		吸烟史	饮酒史	<24		≥24	合并心血管疾病	合并脑血管疾病	合并高血压		合并糖尿病
观察组	12		26		12		23	25	24		26	21	15	31		14
对照组	10		15		25		26	28	23		27	19	17	30		16
$t$ /χ²值	9.874						0.360	0.185	0.112			0.167	0.184	0.838		0.190
$P$ 值	0.007						0.548	0.663	0.714			0.683	0.668	0.042		0.662

Tab. 1 Comparison of general data between the two groups ( n)

组别	例数	年龄 (岁)		性别			病程			文化程度				婚姻状态		工作状态
组别	例数	年龄 (岁)		男		女	<2年	2~4年	≥5年	小学及初中		中专及高中	大专及以上	已婚	未婚	在职	非在职
观察组	50	38.18±8.61		25		25	12	19	19	11		23	16	43	7	38	12
对照组	50	36.98±9.87		27		23	28	15	7	5		28	17	42	8	21	29
$t$ /χ²值		-0.674		0.160			10.078			0.196				0.078		11.947
$P$ 值		0.440		0.689			0.005			0.558				0.779		0.001
组别	家庭人均月收入(元)						吸烟史	饮酒史	BMI(kg/m²)			合并心血管疾病	合并脑血管疾病	合并高血压		合并糖尿病
组别	4000~8000		>8000		≤4000		吸烟史	饮酒史	<24		≥24	合并心血管疾病	合并脑血管疾病	合并高血压		合并糖尿病
观察组	12		26		12		23	25	24		26	21	15	31		14
对照组	10		15		25		26	28	23		27	19	17	30		16
$t$ /χ²值	9.874						0.360	0.185	0.112			0.167	0.184	0.838		0.190
$P$ 值	0.007						0.548	0.663	0.714			0.683	0.668	0.042		0.662

Tab. 2 Comparison of laboratory indexes between the two groups ($\bar{x}±s$)

组别	例数		eGFR [ml/(min· 1.73 m²)]			24小时尿蛋白排泄量(g/d)			尿红细胞计数 (个/μL)		尿白细胞计数 (个/μL)			C-RP (mg/L)			中性粒细胞计数(×10⁹/L)			HDL-C (mmol/L)			LDL-C (mmol/L)
观察组	50		89.12±6.47			1.12±0.65			64.36±21.33		7.18±1.42			1.70±0.72			3.97±0.60			1.32±0.69			2.94±1.29
对照组	50		95.80±8.99			1.36±0.70			61.64±18.33		6.94±1.15			1.95±0.78			4.28±0.77			1.46±0.75			2.87±1.34
$t$ /χ²值			0.000			0.663			0.496		0.366			0.104			0.103			0.335			0.774
$P$ 值			4.262			1.728			-0.684		-0.909			1.643			1.671			0.968			-0.287
组别		BUN (mmol/L)		SUA (μmol/L)			TG (mmol/L)			TC (mmol/L)			Cys-C (mg/L)			FPG (mmol/L)			血红蛋白 (g/L)			血清白蛋白 (g/L)
观察组		5.84±1.08		394.20±36.46			1.10±0.62			4.71±0.54			1.09±0.63			4.52±0.44			118.40±14.04			32.84±4.76
对照组		5.91±1.28		354.68±23.54			1.14±0.69			4.46±0.79			0.97±0.65			4.38±0.75			126.12±7.92			35.08±4.35
$t$ /χ²值		0.296		-6.438			0.304			-1.771			-0.928			-1.116			3.384			2.345
$P$ 值		0.889		0.000			0.762			0.071			0.356			0.246			0.001			0.016
组别		C1q (mg/L)			C3 (g/L)			C4 (g/L)				IgG (g/L)			IgE (IU/ml)			IgA (g/L)			IgM (g/L)
观察组		173.64±17.13			1.04±0.66			0.22±0.17				10.76±2.06			61.28±4.75			2.94±0.84			1.03±0.33
对照组		166.16±20.59			0.81±0.25			0.23±0.15				10.88±3.24			59.16±4.91			3.15±1.00			1.10±0.62
$t$ /χ²值		-1.970			-2.260			0.374				0.221			-1.259			1.144			0.761
$P$ 值		0.052			0.026			0.709				0.826			0.089			0.256			0.449

Tab. 2 Comparison of laboratory indexes between the two groups ($\bar{x}±s$)

组别	例数		eGFR [ml/(min· 1.73 m²)]			24小时尿蛋白排泄量(g/d)			尿红细胞计数 (个/μL)		尿白细胞计数 (个/μL)			C-RP (mg/L)			中性粒细胞计数(×10⁹/L)			HDL-C (mmol/L)			LDL-C (mmol/L)
观察组	50		89.12±6.47			1.12±0.65			64.36±21.33		7.18±1.42			1.70±0.72			3.97±0.60			1.32±0.69			2.94±1.29
对照组	50		95.80±8.99			1.36±0.70			61.64±18.33		6.94±1.15			1.95±0.78			4.28±0.77			1.46±0.75			2.87±1.34
$t$ /χ²值			0.000			0.663			0.496		0.366			0.104			0.103			0.335			0.774
$P$ 值			4.262			1.728			-0.684		-0.909			1.643			1.671			0.968			-0.287
组别		BUN (mmol/L)		SUA (μmol/L)			TG (mmol/L)			TC (mmol/L)			Cys-C (mg/L)			FPG (mmol/L)			血红蛋白 (g/L)			血清白蛋白 (g/L)
观察组		5.84±1.08		394.20±36.46			1.10±0.62			4.71±0.54			1.09±0.63			4.52±0.44			118.40±14.04			32.84±4.76
对照组		5.91±1.28		354.68±23.54			1.14±0.69			4.46±0.79			0.97±0.65			4.38±0.75			126.12±7.92			35.08±4.35
$t$ /χ²值		0.296		-6.438			0.304			-1.771			-0.928			-1.116			3.384			2.345
$P$ 值		0.889		0.000			0.762			0.071			0.356			0.246			0.001			0.016
组别		C1q (mg/L)			C3 (g/L)			C4 (g/L)				IgG (g/L)			IgE (IU/ml)			IgA (g/L)			IgM (g/L)
观察组		173.64±17.13			1.04±0.66			0.22±0.17				10.76±2.06			61.28±4.75			2.94±0.84			1.03±0.33
对照组		166.16±20.59			0.81±0.25			0.23±0.15				10.88±3.24			59.16±4.91			3.15±1.00			1.10±0.62
$t$ /χ²值		-1.970			-2.260			0.374				0.221			-1.259			1.144			0.761
$P$ 值		0.052			0.026			0.709				0.826			0.089			0.256			0.449

Tab. 3 Comparison of kidney pathological between the two groups ($\bar{x}±s$)

组别	例数		免疫球蛋白沉积强度							补体沉积强度				炎细胞浸润程度			血管损伤程度
组别	例数		IgG		IgA		IgM			C3		C1q		炎细胞浸润程度			血管损伤程度
观察组	50		0.26±0.79		3.19±0.45		0.63±0.59			2.02±1.02		0.13±0.39		2.35±1.28			0.78±0.38
对照组	50		0.28±0.56		3.11±0.67		0.56±0.81			2.09±0.34		0.11±0.59		1.79±0.98			0.34±0.46
$t$ /χ²值			0.987		0.856		0.792			0.892		0.689		3.981			4.013
$P$ 值			0.193		0.237		0.339			0.203		0.562		0.005			0.000
组别		牛津病理分型[例(%)]
组别		M0		M1		E0		E1	S0		S1		T0		T1+T2	C0		C1+C2
观察组		2		8		3		3	5		3		8		2	10		6
对照组		1		9		3		2	4		2		10		3	11		5
$t$ /χ²值		0.387
$P$ 值		0.534

Tab. 3 Comparison of kidney pathological between the two groups ($\bar{x}±s$)

组别	例数		免疫球蛋白沉积强度							补体沉积强度				炎细胞浸润程度			血管损伤程度
组别	例数		IgG		IgA		IgM			C3		C1q		炎细胞浸润程度			血管损伤程度
观察组	50		0.26±0.79		3.19±0.45		0.63±0.59			2.02±1.02		0.13±0.39		2.35±1.28			0.78±0.38
对照组	50		0.28±0.56		3.11±0.67		0.56±0.81			2.09±0.34		0.11±0.59		1.79±0.98			0.34±0.46
$t$ /χ²值			0.987		0.856		0.792			0.892		0.689		3.981			4.013
$P$ 值			0.193		0.237		0.339			0.203		0.562		0.005			0.000
组别		牛津病理分型[例(%)]
组别		M0		M1		E0		E1	S0		S1		T0		T1+T2	C0		C1+C2
观察组		2		8		3		3	5		3		8		2	10		6
对照组		1		9		3		2	4		2		10		3	11		5
$t$ /χ²值		0.387
$P$ 值		0.534

Tab. 4 Multivariate analysis of IgA nephropathy complicated with depression

项目	β	$S E$	Wald χ²值	$O R$	$P$ 值	95% $C I$
病程	0.547	0.254	6.651	5.247	0.017	1.016~2.054
工作状态	0.372	0.912	1.658	9.756	0.092	1.014~16.225
家庭人均月收入	1.171	0.124	10.937	3.588	0.003	1.398~1.780
eGFR	1.132	0.054	6.650	0.877	0.010	0.794~0.969
SUA	0.773	0.466	2.215	2.173	0.051	2.121~7.943
血红蛋白	0.234	0.079	11.534	1.840	0.004	1.426~1.870
血清白蛋白	0.208	0.057	11.899	1.246	0.001	1.093~1.403
C3	0.159	0.680	3.104	6.198	0.074	1.816~12.335
炎细胞浸润程度	1.173	0.123	4.937	1.188	0.034	0.932~1.515
血管损伤程度	1.422	0.453	3.914	2.884	0.042	1.038~5.326

Tab. 4 Multivariate analysis of IgA nephropathy complicated with depression

项目	β	$S E$	Wald χ²值	$O R$	$P$ 值	95% $C I$
病程	0.547	0.254	6.651	5.247	0.017	1.016~2.054
工作状态	0.372	0.912	1.658	9.756	0.092	1.014~16.225
家庭人均月收入	1.171	0.124	10.937	3.588	0.003	1.398~1.780
eGFR	1.132	0.054	6.650	0.877	0.010	0.794~0.969
SUA	0.773	0.466	2.215	2.173	0.051	2.121~7.943
血红蛋白	0.234	0.079	11.534	1.840	0.004	1.426~1.870
血清白蛋白	0.208	0.057	11.899	1.246	0.001	1.093~1.403
C3	0.159	0.680	3.104	6.198	0.074	1.816~12.335
炎细胞浸润程度	1.173	0.123	4.937	1.188	0.034	0.932~1.515
血管损伤程度	1.422	0.453	3.914	2.884	0.042	1.038~5.326

Fig. 1 Comparison of survival condition between the two groups

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