Clinical And Pathological Analysis Of Patients With IgA Nephropathy With Hyperhomocysteinemia

Objective:To explore the characteristics of clinical and pathological changes in IgA nephropathy(IgAN)patients with hyperhomocysteinemia(HHCY).Methods:A total of 103 patients in the IgAN disease group diagnosed in the Affiliated Hospital of Chuanbei Medical College from June 2017 to August 2021 were included and divided into hyperhomocysteinemia(HHCY)group(n=42 cases)and non-HHCY groups according to whether the patients were accompanied by HHCY or not.In the hyperhomocysteinemia(non-HHCY)group(n=61 cases),the general data,laboratory indexes and pathological data of the patients were collected.Spearman correlation analysis was used to clarify the correlation between homocysteine and clinical and pathological indicators,binary logistic regression analysis was used to analyze the risk factors of renal tubular atrophy/interstitial fibrosis(T)in lgAN patients,receiver operating characteristic curve(Receiver operating characteristic curve,ROC curve)to assess the predictive ability of homocysteine for tubular atrophy/interstitial fibrosis(T)in IgAN patients.Result:1.Among the 103 patients in this study,42 were combined with HHCY group,accounting for 40.78%of IgAN patients,and most of them were male.2.HHCY group white blood cell count[(6.76±1.75)109/L],neutrophil count[4.09(3.24,5.46)109/L],blood urea nitrogen[5.48(5.00,6.96)μmmol/L],blood Creatinine[99.05(86.25,129.93)μmmol/L],blood uric acid[417.70(349.65,512.83)μmmol/L],24h urine protein[1341.90(665.72,2465.25)g/24h],cystatin C[1.25(1.06),1.70)mg/L],triglycerides[1.57(1.05,2.42)mmol/L],total cholesterol[4.98(4.15,6.48)mmol/L]were higher than those in the non-HHCY group[(6.0±1.61)109/L,3.48(2.90,4.31)109/L,4.75(4.12,5.89)μmmol/L,64.10(51.15,82.80)μmmol/L,339.8(291.75,447.50)μmmol/L,844.70(536.45,1787.00)g/24h,0.96(0.83,1.08)mg/L,1.18(0.86,1.71)mmol/L,4.29(3.83,5.46)mmol/L],eGFR[70.43(53.01,84.97)ml/(min-1.73m2)]It was lower than the non-HHCY group[107.29(88.57,129.85)ml/(min-1.73m2)],and the difference was statistically significant(P<0.05).The proportion of abnormal renal function and normal renal function in the HHCY group was significantly different from that in the non-HHCY group(P<0.01).3.The proportion of Lee’s pathological grade IV+V and the proportion of renal tubular atrophy/interstitial fibrosis(T1+T2)in the Oxford pathological classification in the HHCY group were higher than those in the non-HHCY group(P<0.01).4.Spearman correlation analysis showed that the level of homocysteine and the proportion of male patients,white blood cell count,neutrophil count,blood urea nitrogen,blood creatinine,blood uric acid,total cholesterol,triglyceride,cystatin C,24h Urinary protein,Lee’s pathological grade,and Oxford classification were positively correlated with tubular atrophy/interstitial fibrosis(T),and negatively correlated with eGFR(P<0.05).5.The results of binary logistic regression analysis showed that serum uric acid(OR=1.021,P=0.004),cystatin C(OR=0.006,P=0.009),homocysteine(OR=1.135,P=0.019)and eGFR(OR=0.913,P=0.008)was a risk factor for tubular atrophy/interstitial fibrosis(T)in IgAN patients(P<0.05).ROC curve analysis showed that the area under the curve of homocysteine in predicting renal tubular atrophy/interstitial fibrosis(T)in IgAN patients was 0.768,the best cut-off value was 14.55,the sensitivity was 80.8%,and the specificity was 66.2%.Conclusion:l.The prevalence of HHCY is high in IgAN patients,and it is mainly male.2.Patients with IgAN combined with HHCY may have more severe inflammatory lesions,higher 24h urine protein quantification,and more severe renal damage.3.Homocysteine levels in IgAN patients may be closely related to Lee’s classification and the Oxford classification system for tubular atrophy/interstitial fibrosis(T),and to mesangial hyperplasia(M)and intracapillary hyperplasia(E),segmental glomerulosclerosis(S)and cell/fibrocytic crescent(C)pathological changes have no significant effect.4.Binary Logistic regression analysis showed that serum uric acid,cystatin C,homocysteine and eGFR were risk factors for renal tubular atrophy/interstitial fibrosis(T)in patients with IgAN.Tubular atrophy/interstitial fibrosis(T)has some degree of predictive value.