尿NGAL、KIM-1与免疫球蛋白A肾病患者肾间质纤维化程度的相关性分析

Association of urinary NGAL and KIM-1 with the degree of renal interstitial fibrosis in IgA nephropathy

摘要:

目的 探讨尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肾损伤分子-1（KIM-1）与免疫球蛋白A肾病（IgAN）患者肾间质纤维化程度的相关性。方法 回顾性选取2021年4月—2024年6月南京医科大学附属泰州人民医院收治的IgAN患者104例，按照IgAN患者的肾间质纤维化程度分为轻度组42例、中度组34例、重度组28例，另取同期该院收治的膜性肾病患者（28例）作为疾病对照组，同期该院健康体检者（30例）作为正常对照组。比较各组尿NGAL、KIM-1水平，分析尿NGAL、KIM-1与IgAN患者肾间质纤维化程度的相关性，评价尿NGAL、KIM-1对IgAN患者肾间质纤维化程度的预测价值。结果 尿NGAL、KIM-1水平随肾间质纤维化程度加重逐渐升高（P <0.05）。轻、中、重度组Scr、尿微量白蛋白、24 h尿蛋白定量、尿微量转铁蛋白、肾小球滤过率水平两两比较，差异均有统计学意义（P <0.05）。Spearman相关性分析结果显示，尿NGAL水平（r_s =0.359）、KIM-1水平（r_s =0.413）与IgAN患者肾间质纤维化程度均呈正相关（P <0.05）。受试者工作特征曲线结果表明，尿NGAL、KIM-1单独及联合预测IgAN患者肾间质纤维化程度的敏感性分别为59.7%、67.7%、72.6%，特异性分别为88.1%、85.7%、90.5%，曲线下面积分别为0.794、0.816、0.874。结论 尿NGAL与KIM-1水平与IgAN患者肾间质纤维化严重程度密切相关。NGAL联合KIM-1可作为辅助判断IgAN患者病理严重程度的参考指标，有助于提高患者的治疗效果和预后。

Abstract:

Objective To investigate the association of urinary neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) with the degree of renal interstitial fibrosis in patients with IgA nephropathy (IgAN).Methods A retrospective cohort study was conducted on 104 IgAN patients admitted to Taizhou People's Hospital Affiliated to Nanjing Medical University between April 2021 and June 2024. Patients were stratified into mild (n = 42), moderate (n = 34), and severe (n = 28) groups based on the degree of renal interstitial fibrosis. Concurrently, 28 patients with membranous nephropathy treated at our hospital during the same period served as the disease control group, while 30 healthy volunteers undergoing health checkups at our hospital during the same period served as the normal control group. Urinary NGAL and KIM-1 levels were compared across groups. The correlation between urinary NGAL and KIM-1 levels and the degree of renal interstitial fibrosis in IgAN patients was analyzed. The predictive value of urinary NGAL and KIM-1 for the degree of renal interstitial fibrosis in IgAN patients was evaluated.Results The levels of urinary NGAL and KIM-1 gradually increased with the severity of renal interstitial fibrosis (P < 0.05). Pairwise comparisons among the mild, moderate, and severe groups showed statistically significant differences in the levels of Scr, urinary microalbumin, 24-hour urinary protein quantification, TRF, and eGFR (P < 0.05). Spearman correlation analysis revealed that urinary NGAL levels (r_s = 0.359) and KIM-1 levels (r_s = 0.413) were positively correlated with the degree of renal interstitial fibrosis in IgAN patients (P < 0.05). ROC curve analysis demonstrated that the sensitivities of urinary NGAL and KIM-1, both individually and in combination, for predicting the degree of renal interstitial fibrosis in IgAN patients were 59.7%, 67.7%, and 72.6%, with the specificities being 88.1%, 85.7%, and 90.5%, and the areas under the curves being 0.794, 0.816, and 0.874, respectively.Conclusion Urinary NGAL and KIM-1 levels correlate closely with the severity of renal interstitial fibrosis in IgAN patients. The combination of NGAL and KIM-1 may serve as an auxiliary indicator for assessing the pathological severity of IgAN, thereby contributing to improved treatment outcomes and prognosis.