高BMI与IgA肾病相关性的研究进展
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摘要
免疫球蛋白A肾病(IgAN)是中国最常见的原发性肾小球疾病,可发于任何年龄,呈慢性进行性进展,现有资料显示,约20%～40%IgAN患者10～20年后发展至终末期肾脏病(ESRD)。IgAN进展因素繁多,除公认的免疫因素以外,近年报道体质指数(BMI)、胰岛素抵抗(IR)及高尿酸血症等多种代谢性因素亦和IgAN进展相关。而高BMI患者合并肾脏疾病,也并非均为肥胖相关性肾病,IgAN并不少见。该文就高BMI与IgAN相关性作一综述。
IgAN is the most common primary glomerular disease in China.It can occur at any age and progress chronically.Current data show that about 20%～40% of patients develop to end-stage kidney in 10～20 years.There are many factors contributing to the progress of IgAN.In addition to the recognized immune factors,many metabolic factors such as body mass index,insulin resistance and hyperuricemia have been reported in recent years,which are also related to the progress of IgAN.IgAN is not uncommon in patients with high BMI and kidney diseases,which are not all obesity-related nephropathy.This paper reviews the correlation between high BMI index and IgAN.
IgAN is the most common primary glomerular disease in China.It can occur at any age and progress chronically.Current data show that about 20%～40% of patients develop to end-stage kidney in 10～20 years.There are many factors contributing to the progress of IgAN.In addition to the recognized immune factors,many metabolic factors such as body mass index,insulin resistance and hyperuricemia have been reported in recent years,which are also related to the progress of IgAN.IgAN is not uncommon in patients with high BMI and kidney diseases,which are not all obesity-related nephropathy.This paper reviews the correlation between high BMI index and IgAN.
引文
[1]Zhang C,Zeng X,Li Z,et al.Immunoglobulin a nephropathy:current progress and future directions[J].Transl Res,2015,166(2):134-144.
[2]Kataoka H,Ohara M,Shibui K,et al.Overweight and obesity accelerate the progression of Ig A nephropathy:prognostic utility of a combination of BMI and histopathological parameters[J].Clin Exp Nephrol,2012,16(5):706-712.
[3]Nagaraju SP,Rangaswamy D,Mareddy AS,et al.Impact of body mass index on progression of primary immunoglobulin a nephropathy[J].Saudi J Kidney Dis Transpl,2018,29(2):318-325.
[4]Yonekura Y,Goto S,Sugiyama H,et al.The influences of larger physical constitutions including obesity on the amount of urine protein excretion in primary glomerulonephr itis:research of the Japan Renal Biopsy Registry[J].Clin Exp Nephrol,2015,19:359-370.
[5]Kalaitzidis RG,Siamopoulos KC.The role of obesity in kidney disease:recent findings and potential mechanisms[J].Int Urol Nephrol,2011,43(3):771.
[6]Tanaka M,Yamada S,Iwasaki Y,et al.Impact of obesity on Ig Anephropathy:comparative ultrastructural study between obese and non-obese patients[J].Nephron Clin Pract,2009,112:c71-78.
[7]Okabayashi Y,Tsuboi N,Amano H,et al.Distribution of nephrologists and regional variation in the clinical severity of Ig A nephropathy at biopsy diagnosis in Japan:a cross-sectional study[J].BMJ Open,2018,8(10):e024317.
[8]萨茹拉.表现为少量蛋白尿和(或)血尿Ig A肾病患者的临床-病理与转归研究[D].上海:复旦大学,2010:23-26.
[9]Mestecky J,Raska M,Julian BA,et al.Ig A nephropathy:molecular mechanisms of the disease[J].Annu Rev Pathol,2013,8(1):217-240.
[10]Sevillano AM,Gutiérrez E,Yuste C,et al.Remission of hematuria improves renal survival in Ig A nephropathy[J].J Am Soc Nephrol,2017,32(S3):3089-3099.
[11]Tsuboi N,Utsunomiya Y,Kanzaki G,et al.Low glomerular density with glomerulomegaly in obesity-related glomerulopathy[J].Clin J Am Soc Nephrol,2012,7:735-741.
[12]Skrzypczyk P,Mizerska-Wasiak M,Jerszow B,et al.Ambulatory arterial stiffness index,blood pressure variability,and nocturnal blood pressure dip in children with Ig A and Henoch-Sch9nlein nephropathy[J].Clin Nephrol,2017,87:301-309.
[13]李申恒,史伟,王文健,等.Ig A肾病高血压发生的危险因素分析[J].中华内科杂志,2008,47(11):893-896.
[14]Rutkowski P,Klassen A,Sebekova K,et al.Renal disease in obesity:the need for greater attention[J].J Ren Nutr,2006,16(3):216-223.
[15]Fox CS,Larson MG,Leip EP,et al.Predictors of new-onset kidney disease in a community-based population[J].Jama,2014,291(7):844-850.
[16]Tsuboi N,Utsunomiya Y,Kanzaki G,et al.Low glomerular density with glomerulomegaly in obesity-related glomerulopathy[J].Clin J Am Soc Nephrol,2012,7:735-741.
[17]吴限,何伟春,杨俊伟,等.Ig A肾病合并肥胖相关性肾病的临床病理特征及文献复习[J].中国中西医结合肾病杂志,2014,12(15):1108-1109.
[18]Jang WS,Jeong KH,Moon JY,et al.Relationship between glomerulomegaly and clinicopathologic findings in Ig A nephropathy[J].Clin Nephrol,2012,78:470-477.
[19]Shimamoto M,Ohsawa I,Suzuki H,et al.Impact ofbody mass index on progression of Ig A nephropathy among Japanese patients[J].J Clin Lab Anal,2015,29(5):353-360.
[20]Kato S,Nazneen A,Nakashima Y,et al.Pathological influence of obesity on renal structural changes in chronic kidney disease[J].Clin Exp Nephrol,2009,13(4):332.
[21]马也娉,李荣山,王晨,等.192例Ig A肾病临床与牛津病理分型的分析[J].中国医师杂志,2013,15(1):42-45.
[22]Moorhead JF,Chan MK,EI-Nahas M,et al.Lipid nephrotox-icity in chronic progressive glomerular and tubulointerstitial disease[J].Lancet,2002,2(8311):1309-1311.
[23]丁奕,田娜,周晓玲,等.肥胖与Ig A肾病患者独立肾脏风险因子的相关性分析[J].中华肾脏病杂志,2017,33(5):321-326.
[24]Stefan G,Ismail G,Stancu S,et al.Validation study of oxford classification of Ig A nephropathy:the significance of extracapillary hypercellularity and mesangial Ig G immunostaining[J].Pathol Int,2016,66:453-459.
[25]Yang Y,Wei RB,Wang YD,et al.Higher HOMA-IR index and correlated factors of insulin resistance in patients with Ig A nephropathy[J].Clin Nephrol,2012,78:353-358.
[26]Jia X,Pan X,Xie J,et al.The importance of sensitive screening for abnormal glucose metabolism in patients with Ig A nephropathy[J].Clin Nephrol,2016,85:30-37.
[27]贾晓媛,潘晓霞,谢静远,等.Ig A肾病患者糖代谢异常和胰岛素抵抗的研究[J].中国中西医结合肾病杂志,2012,13(6):495-500.
[28]Yasuyuki N,Ryohei Y,Tatsuya S,et al.Serum uric acid level predicts progression of Ig A nephropathy in females but not in males[J].Plos One,2016,11(8):e0160828.
[29]列才华,谢院生,陈香美,等.超重和肥胖对Ig A肾病患者临床及病理指标的影响[J].北京医学,2009,31(3):141-145.
[30]Zhu B,Yu DR,Lv JC,et al.Uric acid as a predictor of immunoglobulin a nephropathy progression:a cohort study of 1965 cases[J].Am J Nephrol,2018,48(2):127.
[31]徐杨,程虹,谌贻璞,等.代谢综合征对Ig A肾病患者病情的影响[J].中华肾脏病杂志,2010,26(8):578-581.
[32]秦菊,李璐,廖蕴华,等.高脂血症对原发性Ig A肾病的临床及病理影响[J].微创医学,2015,10(3):287-289.
[33]Zhang YM.Update on treatment of immunoglobulin a nephropathy[J].Nephrology(Carlton),2018,23(S4):62-67.
[34]Berthoux F,Mariat C,Maillard N.Overweight/obesity revisited as a predictive risk factor in primary Ig A nephropathy[J].Nephrol Dial Transplant,2013,28(S4):160-166.
[35]Ouyang Y,Xie J,Yang M,et al.Underweight is an independent risk factor for renal function deterioration in patients with Ig A nephropathy[J].Plos One,2016,11(9):e0162044.
[2]Kataoka H,Ohara M,Shibui K,et al.Overweight and obesity accelerate the progression of Ig A nephropathy:prognostic utility of a combination of BMI and histopathological parameters[J].Clin Exp Nephrol,2012,16(5):706-712.
[3]Nagaraju SP,Rangaswamy D,Mareddy AS,et al.Impact of body mass index on progression of primary immunoglobulin a nephropathy[J].Saudi J Kidney Dis Transpl,2018,29(2):318-325.
[4]Yonekura Y,Goto S,Sugiyama H,et al.The influences of larger physical constitutions including obesity on the amount of urine protein excretion in primary glomerulonephr itis:research of the Japan Renal Biopsy Registry[J].Clin Exp Nephrol,2015,19:359-370.
[5]Kalaitzidis RG,Siamopoulos KC.The role of obesity in kidney disease:recent findings and potential mechanisms[J].Int Urol Nephrol,2011,43(3):771.
[6]Tanaka M,Yamada S,Iwasaki Y,et al.Impact of obesity on Ig Anephropathy:comparative ultrastructural study between obese and non-obese patients[J].Nephron Clin Pract,2009,112:c71-78.
[7]Okabayashi Y,Tsuboi N,Amano H,et al.Distribution of nephrologists and regional variation in the clinical severity of Ig A nephropathy at biopsy diagnosis in Japan:a cross-sectional study[J].BMJ Open,2018,8(10):e024317.
[8]萨茹拉.表现为少量蛋白尿和(或)血尿Ig A肾病患者的临床-病理与转归研究[D].上海:复旦大学,2010:23-26.
[9]Mestecky J,Raska M,Julian BA,et al.Ig A nephropathy:molecular mechanisms of the disease[J].Annu Rev Pathol,2013,8(1):217-240.
[10]Sevillano AM,Gutiérrez E,Yuste C,et al.Remission of hematuria improves renal survival in Ig A nephropathy[J].J Am Soc Nephrol,2017,32(S3):3089-3099.
[11]Tsuboi N,Utsunomiya Y,Kanzaki G,et al.Low glomerular density with glomerulomegaly in obesity-related glomerulopathy[J].Clin J Am Soc Nephrol,2012,7:735-741.
[12]Skrzypczyk P,Mizerska-Wasiak M,Jerszow B,et al.Ambulatory arterial stiffness index,blood pressure variability,and nocturnal blood pressure dip in children with Ig A and Henoch-Sch9nlein nephropathy[J].Clin Nephrol,2017,87:301-309.
[13]李申恒,史伟,王文健,等.Ig A肾病高血压发生的危险因素分析[J].中华内科杂志,2008,47(11):893-896.
[14]Rutkowski P,Klassen A,Sebekova K,et al.Renal disease in obesity:the need for greater attention[J].J Ren Nutr,2006,16(3):216-223.
[15]Fox CS,Larson MG,Leip EP,et al.Predictors of new-onset kidney disease in a community-based population[J].Jama,2014,291(7):844-850.
[16]Tsuboi N,Utsunomiya Y,Kanzaki G,et al.Low glomerular density with glomerulomegaly in obesity-related glomerulopathy[J].Clin J Am Soc Nephrol,2012,7:735-741.
[17]吴限,何伟春,杨俊伟,等.Ig A肾病合并肥胖相关性肾病的临床病理特征及文献复习[J].中国中西医结合肾病杂志,2014,12(15):1108-1109.
[18]Jang WS,Jeong KH,Moon JY,et al.Relationship between glomerulomegaly and clinicopathologic findings in Ig A nephropathy[J].Clin Nephrol,2012,78:470-477.
[19]Shimamoto M,Ohsawa I,Suzuki H,et al.Impact ofbody mass index on progression of Ig A nephropathy among Japanese patients[J].J Clin Lab Anal,2015,29(5):353-360.
[20]Kato S,Nazneen A,Nakashima Y,et al.Pathological influence of obesity on renal structural changes in chronic kidney disease[J].Clin Exp Nephrol,2009,13(4):332.
[21]马也娉,李荣山,王晨,等.192例Ig A肾病临床与牛津病理分型的分析[J].中国医师杂志,2013,15(1):42-45.
[22]Moorhead JF,Chan MK,EI-Nahas M,et al.Lipid nephrotox-icity in chronic progressive glomerular and tubulointerstitial disease[J].Lancet,2002,2(8311):1309-1311.
[23]丁奕,田娜,周晓玲,等.肥胖与Ig A肾病患者独立肾脏风险因子的相关性分析[J].中华肾脏病杂志,2017,33(5):321-326.
[24]Stefan G,Ismail G,Stancu S,et al.Validation study of oxford classification of Ig A nephropathy:the significance of extracapillary hypercellularity and mesangial Ig G immunostaining[J].Pathol Int,2016,66:453-459.
[25]Yang Y,Wei RB,Wang YD,et al.Higher HOMA-IR index and correlated factors of insulin resistance in patients with Ig A nephropathy[J].Clin Nephrol,2012,78:353-358.
[26]Jia X,Pan X,Xie J,et al.The importance of sensitive screening for abnormal glucose metabolism in patients with Ig A nephropathy[J].Clin Nephrol,2016,85:30-37.
[27]贾晓媛,潘晓霞,谢静远,等.Ig A肾病患者糖代谢异常和胰岛素抵抗的研究[J].中国中西医结合肾病杂志,2012,13(6):495-500.
[28]Yasuyuki N,Ryohei Y,Tatsuya S,et al.Serum uric acid level predicts progression of Ig A nephropathy in females but not in males[J].Plos One,2016,11(8):e0160828.
[29]列才华,谢院生,陈香美,等.超重和肥胖对Ig A肾病患者临床及病理指标的影响[J].北京医学,2009,31(3):141-145.
[30]Zhu B,Yu DR,Lv JC,et al.Uric acid as a predictor of immunoglobulin a nephropathy progression:a cohort study of 1965 cases[J].Am J Nephrol,2018,48(2):127.
[31]徐杨,程虹,谌贻璞,等.代谢综合征对Ig A肾病患者病情的影响[J].中华肾脏病杂志,2010,26(8):578-581.
[32]秦菊,李璐,廖蕴华,等.高脂血症对原发性Ig A肾病的临床及病理影响[J].微创医学,2015,10(3):287-289.
[33]Zhang YM.Update on treatment of immunoglobulin a nephropathy[J].Nephrology(Carlton),2018,23(S4):62-67.
[34]Berthoux F,Mariat C,Maillard N.Overweight/obesity revisited as a predictive risk factor in primary Ig A nephropathy[J].Nephrol Dial Transplant,2013,28(S4):160-166.
[35]Ouyang Y,Xie J,Yang M,et al.Underweight is an independent risk factor for renal function deterioration in patients with Ig A nephropathy[J].Plos One,2016,11(9):e0162044.