A single-center retrospective study of ectopic lymphoid tissues in idiopathic membranous nephropathy: clinical pathological characteristics and prognostic value.

IF 2.3 3区 生物学 Q2 MULTIDISCIPLINARY SCIENCES
PeerJ Pub Date : 2024-12-09 eCollection Date: 2024-01-01 DOI:10.7717/peerj.18703
Jing Zhang, Siyu Chen, Haiying Zheng, Siyi Rao, Yuanyuan Lin, Jianxin Wan, Yi Chen
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引用次数: 0

Abstract

Background: In recent years, ectopic lymphoid tissue (ELT) has been increasingly confirmed as a new biomarker for kidney injury or inflammation. However, there is insufficient research on the relationship between ELT grading and the progression of idiopathic membranous nephropathy (IMN).

Methods: A total of 147 patients with biopsy-proven IMN in our institution from March 2020 to June 2022 were classified into five grades based on the different distribution of lymphocyte subsets in renal tissue (G0: no B cells or T cells, G1: scattered B and T cells, G2: clustered B and T cells, G3: an aggregation region of B and T cells without a central network, G4: highly organized and formed zones of B and T cells with a central network of follicular dendritic cells and scattered macrophages), and were further divided into low-grade group (G0+G1), intermediate-grade group (G2) and high-grade group (G3+G4). The clinicopathological data, induction treatment response and prognosis among the three groups were analyzed and compared retrospectively.

Results: As the grading of ectopic lymphoid tissues increased, patients were older, with a higher prevalence of hypertension, a higher 24-h urinary protein level, lower baseline hemoglobin and estimated glomerular filtration rate (eGFR) levels, and more severe renal pathological damage. Logistic regression analysis showed that after 6 months of induction treatment, patients in the high-grade group were more likely to be in non-remission than those in the low-grade group (odds ratios [ORs] of the three adjusted models were 4.310, 4.239, and 5.088, respectively, P-values were 0.005, 0.006, and 0.001, respectively). Kaplan-Meier survival analysis indicated that patients in the intermediate- and high-grade groups had significantly lower renal cumulative survival rate than those in the low-grade group (P = 0.025). Univariate Cox analysis showed that the risk of adverse renal outcome was 3.662 times higher in the intermediate- and high-grade groups than in the low-grade group (95% confidence interval [CI] [1.078-12.435]; P = 0.037). Multivariate Cox analysis revealed that failure of remission at the first 6 months (hazard ratio [HR] = 5.769; 95% CI [1.854-17.950]; P = 0.002) remained an independent risk factor for poor renal outcome in patients with IMN.

Conclusions: Grading of renal ectopic lymphoid tissues correlates with disease activity and severity in IMN patients and can be used as an indicator to assess the risk of IMN progression.

特发性膜性肾病异位淋巴组织的单中心回顾性研究:临床病理特征和预后价值。
背景:近年来,异位淋巴组织(ELT)作为肾脏损伤或炎症的一种新生物标志物已被越来越多地证实。然而,关于异位淋巴组织分级与特发性膜性肾病(IMN)进展之间关系的研究尚不充分:根据淋巴细胞亚群在肾组织中的不同分布,将我院 2020 年 3 月至 2022 年 6 月期间活检证实的 147 例 IMN 患者分为五个等级(G0:无 B 细胞或 T 细胞;G1:散在的 B 细胞和 T 细胞;G2:聚集的 B 细胞和 T 细胞;G3:B 细胞和 T 细胞聚集区;G4:B 细胞和 T 细胞聚集区;G5:B 细胞和 T 细胞聚集区;G6:B 细胞和 T 细胞聚集区;G7:B 细胞和 T 细胞聚集区;G8:B 细胞和 T 细胞聚集区):进一步分为低级别组(G0+G1)、中级别组(G2)和高级别组(G3+G4)。对三组的临床病理数据、诱导治疗反应和预后进行了回顾性分析和比较:随着异位淋巴组织分级的增加,患者年龄越大,高血压患病率越高,24小时尿蛋白水平越高,基线血红蛋白和估计肾小球滤过率(eGFR)水平越低,肾脏病理损伤越严重。逻辑回归分析表明,经过6个月的诱导治疗后,高级别组患者比低级别组患者更有可能处于非缓解状态(三个调整模型的几率比[ORs]分别为4.310、4.239和5.088,P值分别为0.005、0.006和0.001)。卡普兰-梅耶生存分析表明,中度和高度组患者的肾脏累积生存率明显低于低度组(P = 0.025)。单变量 Cox 分析显示,中、高分级组发生肾脏不良预后的风险是低分级组的 3.662 倍(95% 置信区间 [CI] [1.078-12.435];P = 0.037)。多变量 Cox 分析显示,头 6 个月未能缓解(危险比 [HR] = 5.769;95% CI [1.854-17.950];P = 0.002)仍是 IMN 患者肾脏预后不佳的独立危险因素:结论:肾脏异位淋巴组织的分级与IMN患者的疾病活动性和严重程度相关,可作为评估IMN进展风险的指标。
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来源期刊
PeerJ
PeerJ MULTIDISCIPLINARY SCIENCES-
CiteScore
4.70
自引率
3.70%
发文量
1665
审稿时长
10 weeks
期刊介绍: PeerJ is an open access peer-reviewed scientific journal covering research in the biological and medical sciences. At PeerJ, authors take out a lifetime publication plan (for as little as $99) which allows them to publish articles in the journal for free, forever. PeerJ has 5 Nobel Prize Winners on the Board; they have won several industry and media awards; and they are widely recognized as being one of the most interesting recent developments in academic publishing.
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