Association Of Serum Bilirubin With Clinical And Pathological Features In Patients With IgA Nephropathy

Objective: To investigate the relationship between different levels of serum total bilirubin(TBIL),direct bilirubin(DBIL)and indirect bilirubin(IBIL)with other clinical indicators and pathological features in patients with IgA nephropathy(IgAN).Methods: This study is a retrospective study.By selecting the patients who underwent renal puncture biopsy in the Department of Nephrology of our hospital from January 1,2019 to November 10,2022,and were diagnosed as IgAN.Detailed clinical and pathological data of patients were collected at the time of hospitalization.According to the median of TBIL,DBIL and IBIL,patients with IgAN were divided into low TBIL group(TBIL< 11.510umol/L,n=96),high TBIL group(TBIL> 11.510umol/L,n=96).Low DBIL group(DBIL<2.575umol/L,n=96),high DBIL group(DBIL>2.575umol/L,n=96);Low IBIL group(IBIL<8.770 umol/L,n=96),high IBIL group(IBIL>8.770umol/L,n=96).To analyze the correlation between different levels of TBIL,DBIL,IBIL and other clinical indicators and pathological characteristics of IgAN patients,and to analyze the risk factors of glomerular mesangial cell proliferation(Oxford classification M1)in IgAN patients by logistic regression.Results:(1)A total of 192 patients with IgAN were included in this study,of which 86(44.8%)were male patients and 106(55.2%)were female patients.Their average age was(39.44 ± 12.78)years old.(2)To compare the clinical indicators of patients with different types of bilirubin levels.Compared with the high TBIL group,the low TBIL group had higher levels of 24-hour urine protein,lower levels of total protein,albumin,hemoglobin,male ratio,and alanine aminotransferase levels,and the difference was statistically significant(P<0.05).Compared with the high DBIL group,the low DBIL group had higher levels of 24-hour urine protein,total cholesterol,triglyceride and low density lipoprotein,and lower levels of total protein,albumin,hemoglobin,male ratio,and alanine aminotransferase,and the difference was statistically significant(P<0.05).Compared with the high IBIL group,the low IBIL group had higher levels of 24-hour urine protein,lower levels of total protein,albumin,hemoglobin,male ratio,and alanine aminotransferase,and the difference was statistically significant(P<0.05).Spearman correlation analysis showed that TBIL,DBIL,IBIL were negatively correlated with24-hour urine protein(P<0.05),and positively correlated with hemoglobin,total protein and albumin(P<0.05).DBIL was negatively correlated with total cholesterol,triglyceride and low density lipoprotein(P<0.05).(3)Pathological data of patients with different types of bilirubin levels were compared.Compared with the high TBIL group,patients with low TBIL had a higher incidence of mesangial cell proliferation(Oxford classification M1),and the difference was statistically significant(P<0.05).Compared with the high IBIL group,patients with low IBIL had a higher incidence of mesangial cell proliferation(Oxford classification M1)and cellular/fibrocytic crescent(Oxford classification C1 and C2),and the difference was statistically significant(P<0.05).(4)Multivariate logistic regression analysis showed that IBIL was a protective factor for mesangial cell proliferation(Oxford classification M1)in patients with IgAN.Conclusion:(1)Low TBIL,DBIL,and IBIL in IgAN patients indicate that the relevant clinical indicators(24h UP,total protein,albumin,hemoglobin)are relatively more serious,and DBIL is negatively correlated with blood lipids.(2)Low TBIL and IBIL in IgAN patients indicate more serious renal injury.(3)IBIL is protective factors for glomerular mesangial cell proliferation in IgAN patients(Oxford classification M1).