Correlation And Risk Factors Analysis Of Immunoglobulin And Complement With Clinical Manifestations And The Oxford Classification Of IgAN

Objective:1.The correlation between immunoglobulin and complement(IgG,IgM,IgA,C3,C4)and the clinical and pathological manifestations of IgAN was retrospectively analyzed,so as to provide new ideas for the clinical study of IgAN from the point of pathogenesis.2.Risk factors of the Oxford classification were retrospectively analyzed to provide new markers for predicting the severity of pathological manifestations from the perspective of clinical manifestations.Methods:1.The clinical basic data,laboratory data and pathological data of 535 patients with primary IgAN confirmed by renal biopsy in the Department of Nephrology of the Second Hospital of Jilin University from January 1,2012 to August 31,2020 were collected.2.Statistical software such as SPSS25.0 and Graph Pad Prism7.0 were used for data analysis and graphical analysis.Results:1.A total of 535 cases of primary IgAN were collected in this study,mostly male patients,and the male to female ratio was 1.14:1.The mean age of IgAN patients at renal biopsy was 37(28,46)years,with fewer cases of IgAN over 60 years of age.27.41% of IgAN patients had pre-onset inducement,and 14.21% of IgAN patients treated with gross hematuria as the first symptom.The proportions of M1 and S1 of the Oxford classification were 78.5% and 82.1%respectively.2.IgG levels were higher in IgAN patients with a previous history of tonsillitis(P<0.01),were lower in male and edematous IgAN patients(P<0.05).IgG levels were positively correlated with BMI,LY%,LY,Alb,e GFR,IgA,IgM levels(P<0.05),negatively correlated with the levels of NE%,NE,24h-UPRO,BUN,Scr,Cys-C,TC,HDL-C and LDL-C(P<0.05).IgG was associated with E,T,and C lesions of the Oxford classification(P<0.05),but not an independent risk factor for pathology.3.IgA levels were lower in edematous IgAN patients and higher in patients with microscopic hematuria(P<0.05).IgA levels were positively correlated with BMI,LY%,LY,hs-CRP,WBC/HPF,RBC/HPF(P<0.05),negatively correlated with NE%,TC,HDL-C,LDL-C and C3levels(P<0.05).There was no correlation between IgAN and the Oxford classification.4.Lower IgM levels were in male IgAN patients(P<0.0001),higher IgM levels were in lumbaginous IgAN patients(P<0.01).IgM levels were positively correlated with WBC/HPF,HDL-C and C3 levels(P<0.05),and were negatively correlated with the levels of Hb,BUN,Scr,UA and hypertension(P<0.05).IgM was associated with T and C lesions of the Oxford classification(P<0.05),and low level of IgM was an independent risk factor for C lesion(P<0.05).5.C3 levels were higher in IgAN patients with a previous history of tonsillitis(P<0.01),lower in IgAN patients with microscopic hematuria(P<0.01).The levels of BMI,LY,MNC,Hb,hs-CRP,24h-URPO,TG,TC,LDL-C,UA,C4 were positively correlated with C3 levels(P<0.05).There was a negative correlation between HDL-C and C3(P<0.05).C3 was not only associated with M lesion of the Oxford classification,but also low level of C3 was an independent risk factor for M lesion(P<0.05).6.Higher C4 levels were in male IgAN patients(P<0.0001).The levels of BMI,WBC,MNC%,MNC,hs-CRP,LDL-C,24h-UPRO,BUN,UA,Scr,Cys-C and hypertension were positively correlated with C4 levels(P<0.05),and the levels of HDL-C,Alb and e GFR were negatively correlated with C4 levels(P<0.05).C4 levels were associated with T and C lesions of the Oxford classification(P<0.01),and high level of C4 was an independent risk factor for the C lesion(P<0.01).7.Analyze the risk factors of the Oxford classification(M,E,S,T,C),and it was found that the sensitivity and specificity of most risk factors in the diagnosis of the Oxford classification were poor.However,Cys-C and e GFR were not only independent risk factors of the T lesion of the Oxford classification,but also had good sensitivity and specificity in the diagnosis of T lesion.Conclusion:1.IgAN tends to occur in young people,mostly in male patients,and male patients tend to have low IgG,low IgM,and high C4.About 30% of the patients had inducement before onset,among which IgG and C3 levels were related to tonsil infection and IgM might be related to urinary tract infection.2.Low IgG,low IgM,and high C4 were associated with renal function impairment,while high IgA and low C3 were associated with microscopic hematuria.3.In the Oxford classification,M and S lesions accounted for a higher proportion.Low C3 was an independent risk factor for M lesion,low IgM and high C4 were independent risk factors for C lesion,and Cys-C was an independent risk factor for T lesion with a good diagnostic value.