Association Of Clinical Helicobacter Pylori Infection With IgA Nephropathy

Objective:Epidemiological studies have demonstrated that IgA nephropathy（IgAN）is one of the most common types of primary glomerular disease in the world according to the pathological results of renal biopsy.The main pathological feature of IgA nephropathy is IgA immunoglobulin or IgA-based immunoglobulin complex deposited in the glomerular mesangial area.Currently,the pathogenesis of IgA nephropathy is not completely clear.Infection factors,immune factors and genetic factors may be related to its occurrence and progress.A lot of epidemiological studies suggest that Helicobacter pylori（HP）infection may be associated with multiple human autoimmune diseases including IgA nephropathy.Helicobacter pylori infection may cause or aggravate IgA nephropathy by cross-immune response.This study was performed to explore the association between HP infection and IgA nephropathy in human,explore the influence of HP infection on biochemical indicators,inflammatory markers,pathological lesions in IgA nephropathy patients.To further research the relationship between HP infection and IgA nephropathy,providing new ideas and methods for the prevention and treatment of IgA nephropathy.Method:We selected 344 patients with primary glomerular disease,which were confirmed by pathological results from November 2016 to November 2017 in the renal division of Qingdao university affiliated hospital.There were 332 cases in conformity with the inclusion criteria.The cohort consists of 97 IgA nephropathy patients and 235non-IgA primary glomerular disease patients.Most of the non-IgA patients were confirmed as Idiopathic membranous nephropathy（IMN）patients according to their pathological results.However,the number of primary glomerular diseases patients with other pathological types is small,which makes the analysis less significant.Therefore,we only selected IMN patients for statistical analysis in this study.We also selected 60healthy subjects with no basic kidney diseases as control group.All subjects accepted¹³C-urea breath test,enzyme linked immunosorbent assay（ELISA）to to to detect the HP infection status.We also analyzed the detailed information about IgA and IMN patients,including gender,age,height,weight,blood pressure,past history,and family medical history.Blood and urine biochemical studies included total cholesterol（TC）,triglycerides（TG）,high-density lipoprotein（HDL）,low density lipoprotein（LDL）,serum creatinine（SCr）,urea nitrogen（BUN）,uric acid（UA）,fasting blood glucose（FBG）,urine red blood cell（URBC）,24-hour urinary protein,serum albumin（ALB）and figure out estimated glomerular filtration rate（eGFR）.The indicators of inflammation included white blood cells（WBC）,Neutrophil（NEU）,hypersensitive c-reactive protein（CRP）,blood sedimentation（ESR）,calcitonin（PCT）.The pathological examination results were collected and analyzed at the same time.Results:The current HP infection rate of IgA nephropathy patients is slightly higher than idiopathic membranous nephropathy patients and healthy people,but there was no statistic difference（P>0.05）.In HP positive-infected IgA nephropathy group,35samples showed normally renal function,while 14 samples showed abnormal renal function;In non-HP infected group,the corresponding number is 41and 5,respectively.The ratio of the two groups with abnormal renal function and normal renal function showed significantly statistical difference（P<0.05）.IgA nephropathy group HP infection positive abnormal renal function compared with HP infection negative abnormal renal function,HP infection in positive showed reduced SCr,BUN and increased eGFR,and the difference is statistically significant（P<0.05）.Comparison of blood and urine biochemical indexes between HP positive group and HP negative group in IgA nephropathy.IgA nephropathy patients in HP infected group showed increased urine red blood cell and 24-hour urine protein but reduced ALB compared with HP non-infected group,and the difference was statistically significant（P<0.05）.Comparison of inflammatory markers:WBC,NEU,CRP,ESR,and PCT（P<0.05）were slightly higher in the HP infected patients with IgA nephropathy than those in HP non-infected group,but the difference was not statistically significant（P>0.05）.The degree of pathological damage（in accordance with Lee grade）:23 cases of level I in HP infected IgA nephropathy group,19 in grade II,4 in grade III,2 in grade IV,and 1 in V grade;There were 32 cases in the HP non-infected group,11 in grade II,2 in class III,1 in grade IV,0in V,and the comparison between the two groups showed that the level of pathologic lesion of HP infected group was higher than the non-infected group,and the difference was statistically significant（P<0.05）.Conclusion:There was no significant difference in HP infection rate among patients with IgA nephropathy and patients with IMN nephropathy and healthy controls.This research found that renal function impairment in the HP infected IgA nephropathy group was more serious than that in the HP non-infected group.The blood urine red blood cell count and24h urine protein in IgA nephropathy patients with HP infection were significantly higher than those in HP non-infected group.All these results indicate that HP infection may aggravate the condition of IgA nephropathy patients and associate with the progression of IgA nephropathy.