The role of serum total bilirubin level in the prognosis of IgA nephropathy
Objective To investigate the relationship between serum total bilirubin levels and poor renal prognosis in patients with IgA nephropathy(IgAN).Methods To retrospectively analyze the clinical and pathological data of patients with primary IgAN who attended the First People's Hospital of Tianmen in Hubei Province from January 2018 to January 2021 and were diagnosed by renal biopsy.The patients with IgAN were divided into low total bilirubin(TB)group(L-TB group,76 cases)and high bilirubin group(H-TB group,73 cases)according to the median serum total bilirubin level,and the differences in clinical and pathological data between the two groups were compared.Kaplan-Meier survival curves were used to assess the cumulative renal survival of patients,Cox regression modeling was used to analyze the risk factors affecting the progression of IgAN patients,and smoothing curve fit-ting and threshold analysis were used to explore the relationship between serum total bilirubin levels and poor renal prognosis of IgAN.Results Comparison of the baseline data between the two groups showed that low-density lipoprotein was significantly higher in the L-TB group than in the H-TB group,and total serum bilirubin were significantly lower than in the H-TB group(all P＜0.05).The results of Kaplan-Meier survival curve analysis showed that patients in the L-TB group had a significantly higher risk of progression of IgAN than in the H-TB group(x2=5.552,P=0.019).Multi-factor Cox regres-sion analysis showed decreased TB(HR=0.74,95％CI:0.61-0.88,P=0.017),increased blood creatinine(HR=1.30,95％CI:1.21-1.98,P=0.021),and the development of segmental glomeru-losclerosis(S1)(HR=1.48,95％CI:1.22-6.52,P=0.020)as risk factors for disease progression in patients with IgAN.Smoothing curve fitting and threshold effect analysis showed an approximately linear correlation between serum TB level and relative risk of poor renal prognosis(RR)in IgAN.That is,the higher serum TB level,the lower relative risk of poor prognosis in IgAN patients(RR=0.80,95％CI:0.70-0.90,P=0.004).Conclusions Decreased serum total bilirubin level is negatively associated with progression of IgAN and is an independent risk factor for disease progression.
NETL
NSTL
万方数据
维普
