Analysis Of Lipid Parameters And Prognostic Factors In Patients With Membranous Nephropathy

Objective: To analyze the distribution characteristics of lipid parameters in patients with membranous nephropathy,analyze the correlation between lipid parameters and clinicopathological indicators,and explore factors affecting the prognosis of patients with membranous nephropathy.Methods: A retrospective analysis was conducted on 145 patients diagnosed with membranous nephropathy through renal biopsy at the First Affiliated Hospital of Nanchang University from May 2014 to November 2020.Collect the lipid parameter test reports of the subjects(including total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)).Atherogenic index of plasma(AIP)is calculated by the formula [log(TG/HDL-C)],and use ROC curve analysis to obtain the optimal diagnostic threshold for AIP based on the highest Jordan index.Divide patients into a high AIP group(AIP ≥-0.036,N=110)and a low AIP group(AIP<-0.036,N=35),and the clinicopathologic characteristics of the two groups were compared.Measurement data conforming to normal distribution were expressed as mean ± standard deviation,and for non-normal distribution continuous variables,they were expressed as median and interquartile spacing;Counting data is expressed as frequency(%);Two independent samples t-test was used for the comparison between groups of continuous variables with normal distribution,Mann-Whitney test was used for comparison between groups of non-normal distribution continuous variables,and Chi-square test was used for categorical variables.Spearman correlation and univariate Logistic regression analysis were used to compare the correlation between clinicopathologic data and AIP.Univariate Logistic regression was used to evaluate the relationship between clinical and pathological features and the prognosis of patients with membranous nephrotic albuminuria.Then,the significant variables in the univariate Logistic regression analysis were included in the multivariate Logistic regression analysis to analyze the influencing factors on the prognosis of patients with membranous nephropathy.Results:1.The incidence of dyslipidemia in IMN patients was 77.9%,mainly TC combined with elevated LDL-C(31.0%),followed by mixed hyperlipidemia(29.7%),simple high TG(4.1%),simple high TC(1.4%),and low HDL(3.5%).2.Among IMN patients,the incidence of dyslipidemia was 84.0% in males and 66.7% in females.The incidence of dyslipidemia was significantly different between males and females(Chisquare value = 5.804,P = 0.016).3.The proportion of hypertension,body weight,creatinine,24-hour proteinuria,hyperuricemia,TG,TC/HDL-C,TG/HDL-C,LDL-C/HDL-C in the high AIP group was higher than that in the low AIP group(P<0.05),and HDL was lower than that in the low AIP group.4.The proportion of glomerulosclerosis and renal interstitial fibrosis in the high AIP group was higher than that in the low AIP group(P<0.05).5.The correlation analysis showed that body weight(rs=0.269,P < 0.05),24h-UP(rs=0.225,P< 0.05),creatinine(rs=0.206,P < 0.05),and uric acid(rs=0.170,P < 0.05)were positively correlated with AIP.Patients with higher AIP tended to have more severe glomerulosclerosis(OR 2.355,95%CI 1.076-5.154;P=0.032)pathological changes.6.Within 1 year of follow-up,the endpoint was defined as a combination of partial and complete remission.Univariate logistic analysis showed age(OR 0.060,95% CI 0.928-0.993;P=0.018),body weight(OR 0.972,95% CI 0.935-1.010;P=0.105),AIP(OR 3.982,95% CI 1.227-12.973;P=0.022),24-hour proteinuria quantification(OR 1.129,95% CI 0.969-1.314 P=0.119)Renal interstitial fibrosis(OR 1.429,95% CI 0.651-3.136;P=0.174)is a related factor for the remission of proteinuria in membranous nephropathy(P<0.2);Multivariate Logistic analysis showed that body weight(OR 0.948,95% CI 0.905-0.992;P=0.022),AIP(OR 5.388,95% CI 1.287-22.553;P=0.021),quantitative albuminuria at 24h(OR 1.197,95%CI 1.003-1.429;P=0.046)was an independent factor for the remission of membranous nephrotic albuminuria(P < 0.05).Conclusion:1.Dyslipidemia was common in patients with MN,mainly hypercholesterolemia combined with hyper-LDL-C;The incidence of dyslipidemia was higher in male patients than in female patients.2.AIP was positively correlated with body weight,creatinine,uric acid and 24 h albuminuria.The higher AIP was,the higher the degree of glomerular sclerosis was.3.AIP value,24 h albuminuria and body weight were independent risk factors for prognosis of membranous nephropathy albuminuria.