The relationship between blood CCL27,clinical indicators and pathological changes of renal damage in IgAN patients
Objective To investigate the correlation between peripheral blood CCL27 and the degree of renal damage and pathologic staging of IgA nephropathy(IgAN),and to find a convenient and reliable clinical indicator to assist in the diagnosis of IgAN and assessment of disease progression.Methods The clinical data of 122 patients diagnosed as IgAN by renal puncture biopsy in the First People's Hospital of Yunnan Province from February 2021 to August 2022 were selected as the study subjects as the IgAN group,and 39 healthy subjects from physical examination center of hospital were selected as the experimental control group.Plasma CCL27 levels were measured and ROC curves were plotted.According to the median plasma CCL27 level of 1 936.59 ng/mL,the study subjects were di-vided into the high-level CCL27 group(61 cases)and the low-level CCL27 group(61 cases).Ac-cording to the different clinical manifestations of IgAN patients,they were divided into hematuria group(76 cases)and no hematuria group(46 cases),obvious proteinuria group(63 cases)and slight pro-teinuria group(59 cases),estimated glomerular filtration rate(eGFR)normal group(64 cases)and eGFR decreased group(58 cases),hypertension group(66 cases)and normal blood pressure group(56 cases).The plasma CCL27 levels of patients in the subgroups were compared.According to Lee classification,patients with high and low levels of CCL27 were categorized into Ⅰ-Ⅲ group(80 cases)and Lee Ⅳ-V group(42 cases),and the Lee classification lesions of IgAN patients with different lev-els of CCL27 were compared.Then,according to the T classification of MEST-C classification,IgAN group was divided into three groups:T0(32 cases),T1(67 cases)and T2(23 cases),and the plasma CCL27 level of the three groups was compared.To compare the MEST-C classification of IgAN patients with different levels of CCL27.The relationship between CCL27 level and Lee's grade and MEST-C pathological classification of IgAN patients was analyzed.The correlation between CCL27 and serum creatinine(Scr),urinary protein,hypertension,eGFR,blood lipid and other indexes was explored.Results The plasma CCL27 level in IgAN group was higher than that in control group,the difference was statistically significant(P＜0.001).The ROC curve of plasma CCL27 level for the diagnosis of IgAN showed that the area under the curve of CCL27 was 0.7554(95％CI:0.668-0.843)and the specificity was 91.8％(P＜0.001).Blood urea nitrogen(BUN),Scr,uric acid(UA),24 h urinary protein quantity(24 h-UP),urinary protein creatinine ratio(ACR)and incidence of hypertension in the high level CCL27 group level was significantly higher than that of low level CCL27 group,and the cystatin C lever war lower than that in the ouw lever CCL27 group(all P＜0.05).Compared with the mild proteinuria group,the blood CCL27 level of IgAN patients in the obvious proteinuria group was significantly increased(P＜0.05).CCL27 levels were higher in IgAN patients with decreased eGFR compared with those with normal eGFR(P＜0.001).Plasma CCL27 levels were higher in the hyper-tensive group than in the normal blood pressure group(P＜0.001).Compared with the low level CCL27 group,the proportion of grade Ⅳ-Ⅴ lesions in the high level CCL27 group was significantly in-creased(P＜0.05).Compared with the low level CCL27 group,the proportion of T2 lesions in the high level CCL27 group was significantly increased(P＜0.05),while the proportion of T0 lesions was significantly decreased(P＜0.05).Compared with grade Ⅰ-Ⅲ group,the level of CCL27 in gradeⅣ-Ⅴ group was significantly increased(P＜0.05).Compared with T0 and T1 groups,plasma CCL27 levels in T2 group were significantly increased(all P＜0.05).Plasma CCL27 level was positively cor-related with age,BUN,WBC,TC,Scr,UA,24 h-UP,ACR,serum ferritin and cystatin C,while plasma CCL27 level was negatively correlated with eGFR(r=-0.202,P＜0.05).Conclusions El-evated plasma CCL27 is closely associated with IgAN renal function injury,the development of hyperten-sion and pathological damage in IgAN patients,especially tubulointerstitial injury.In conclusion,it is suggested that plasma CCL27 is a good indicator for clinical diagnosis of IgAN.
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