The relationship between body mass index and clinicopathologic characteristics of idiopathic membranous nephropathy

doi:10.11958/20231818

Abstract

Abstract:

Objective To investigate the effect of body mass index (BMI) on the clinicopathological characteristics of patients with idiopathic membranous nephropathy (IMN). Methods A total of 261 patients with IMN were divided into the normal group (66 cases), the overweight group (105 cases) and the obese group (90 cases) according to BMI. Clinical and renal pathological data of patients were compared between the three groups. The correlation between BMI and clinicopathological indexes was analyzed by Pearson or Spearman's correlation. The influencing factors of estimated glomerular filtration rate (eGFR) were analyzed by multiple linear regression, and the influencing factors of interstitial fibrosis (IF), tubular atrophy (TA), glomerulosclerosis (GS) and mesangial cell proliferation (MCP) were analyzed by binary Logistic regression. Results Compared with the normal group, the prevalence of diabetes mellitus, triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) were elevated in the overweight group. The prevalence of hypertension, hemoglobin (HGB), uric acid (UA), LDL-C, TG, 24-h urinary protein (UTP) and serum complement 3 (C3) were elevated, and high-density lipoprotein cholesterol (HDL-C) was decreased in the obese group (P<0.05). The prevalence of hypertension, UA, TG and serum C3 were elevated in the obese group compared to the overweight group (P<0.05). The glomerular basement membrane (GBM) thickness was higher in the obese group and the overweight group than that in the normal group, and the proportion of GS and IF was higher in the obese group than that in the normal group (P<0.05). BMI was positively correlated with hypertension, TG, LDL-C, serum C3, UTP, GS, IF, MCP and deposition in the mesangial region of C3, and negatively correlated with HDL-C (P<0.05). Multiple linear regression analysis showed that age, blood urea nitrogen (BUN), anti-phospholipase A2 receptor antibody (anti-PLA2R), UTP and TA were independent risk factors of eGFR. Binary Logistic regression analysis showed that elevated BMI, age, UTP and serum creatinine (Scr) were independent risk factors for IF. Age, Scr and elevated UA were independent risk factors for TA. Elevated BMI and decreased eGFR were independent risk factors for GS. Elevated BMI was an independent risk factor for MCP. There was no significant difference in the treatment protocol of IMN patients between the three groups. Conclusion Obesity can exacerbate multiple clinical and pathological outcomes in IMN patients.

Key words: body mass index, obesity, glomerulonephritis, membranous, idiopathic membranous nephropathy

CLC Number:

R692

Figures/Tables 8

References 27

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组别		n	年龄/岁	男性	糖尿病	高血压	BMI/（kg/m²）		HGB/（g/L）	ALB/（g/L）	BUN/（mmol/L）	UA/（μmol/L）
正常组		66	50.35±14.21	34（51.52）	4（6.06）	22（33.33）	21.33±1.25		131.64±16.51	24.45±7.33	5.04±1.73	343.92±82.15
超重组		105	52.08±13.25	62（59.05）	21（20.00）^a	45（42.86）	25.96±1.15^a		134.20±20.51	25.19±7.02	4.82±1.59	360.96±93.03
肥胖组		90	49.86±12.53	59（65.56）	14（15.56）	56（62.22）^ab	31.11±3.15^ab		140.18±17.96^a	25.06±6.32	4.95±1.38	403.81±85.66^ab
χ²			0.749	3.121	6.236^＊	14.038^＊	28.217^＊		4.477^＊	0.247	0.415	10.091^＊
组别	Scr/ （μmol/L）		血清C3/ （g/L）	UTP/g	TG/ （mmol/L）		TC/ （mmol/L）	HDL-C/ （mmol/L）	LDL-C/ （mmol/L）	eGFR/ [mL/（min·1.73 m²）]	anti-PLA2R/ （RU/mL）
正常组	63.47±17.41		90.80±17.68	3.08（1.61，5.99）	1.81（1.46，2.36）		7.37±2.21	1.43±0.35	3.76±1.19	103.69±16.06	12.55（0.08，122.34）
超重组	65.62±17.44		92.69±18.24	4.20（2.26，6.57）	2.16（1.56，3.03）^a		7.03±1.96	1.34±0.33	4.43±1.80^a	101.72±17.01	20.35（0.00，113.21）
肥胖组	67.08±15.60		101.69±19.73^ab	4.80（2.81，8.59）^a	2.55（1.81，4.14）^ab		7.33±2.17	1.26±0.32^a	4.45±1.72^a	103.04±15.54	32.40（6.09，122.51）
F或H	0.876		8.255^＊	11.259^＊	22.952^＊		0.719	5.135^＊	6.724^＊	0.332	1.748

组别		n	年龄/岁	男性	糖尿病	高血压	BMI/（kg/m²）		HGB/（g/L）	ALB/（g/L）	BUN/（mmol/L）	UA/（μmol/L）
正常组		66	50.35±14.21	34（51.52）	4（6.06）	22（33.33）	21.33±1.25		131.64±16.51	24.45±7.33	5.04±1.73	343.92±82.15
超重组		105	52.08±13.25	62（59.05）	21（20.00）^a	45（42.86）	25.96±1.15^a		134.20±20.51	25.19±7.02	4.82±1.59	360.96±93.03
肥胖组		90	49.86±12.53	59（65.56）	14（15.56）	56（62.22）^ab	31.11±3.15^ab		140.18±17.96^a	25.06±6.32	4.95±1.38	403.81±85.66^ab
χ²			0.749	3.121	6.236^＊	14.038^＊	28.217^＊		4.477^＊	0.247	0.415	10.091^＊
组别	Scr/ （μmol/L）		血清C3/ （g/L）	UTP/g	TG/ （mmol/L）		TC/ （mmol/L）	HDL-C/ （mmol/L）	LDL-C/ （mmol/L）	eGFR/ [mL/（min·1.73 m²）]	anti-PLA2R/ （RU/mL）
正常组	63.47±17.41		90.80±17.68	3.08（1.61，5.99）	1.81（1.46，2.36）		7.37±2.21	1.43±0.35	3.76±1.19	103.69±16.06	12.55（0.08，122.34）
超重组	65.62±17.44		92.69±18.24	4.20（2.26，6.57）	2.16（1.56，3.03）^a		7.03±1.96	1.34±0.33	4.43±1.80^a	101.72±17.01	20.35（0.00，113.21）
肥胖组	67.08±15.60		101.69±19.73^ab	4.80（2.81，8.59）^a	2.55（1.81，4.14）^ab		7.33±2.17	1.26±0.32^a	4.45±1.72^a	103.04±15.54	32.40（6.09，122.51）
F或H	0.876		8.255^＊	11.259^＊	22.952^＊		0.719	5.135^＊	6.724^＊	0.332	1.748

组别	n	IgG系膜区沉积	IgM系膜区沉积	IgA系膜区沉积	C3系膜区沉积	C4系膜区沉积	GBM厚度/nm	病理分期		GS	TA	IF	MCP
组别	n	IgG系膜区沉积	IgM系膜区沉积	IgA系膜区沉积	C3系膜区沉积	C4系膜区沉积	GBM厚度/nm	Ⅰ—Ⅱ期	Ⅲ—Ⅳ期	GS	TA	IF	MCP
正常组	66	4（4，4）	2（2，2）	0（0，0）	2（2，2）	0（0，0）	1 002.27±224.03	60（90.91）	6（9.09）	20（30.30）	20（30.30）	17（25.76）	54（81.82）
超重组	105	4（4，4）	2（2，2）	0（0，0）	2（2，2）	0（0，0）	1 106.67±274.39^a	89（84.76）	16（15.24）	43（41.95）	41（39.05）	40（38.10）	87（82.86）
肥胖组	90	4（4，4）	2（2，2）	0（0，0）	2（2，2）	0（0，0）	1 103.33±237.95^a	75（83.33）	15（16.67）	46（51.11）^a	42（46.67）	42（46.67）^a	81（90.00）
F、χ²或H		0.207	3.085	1.647	5.312	0.697	4.176^＊	1.959		6.826^＊	4.281	7.073^＊	2.675

组别	n	IgG系膜区沉积	IgM系膜区沉积	IgA系膜区沉积	C3系膜区沉积	C4系膜区沉积	GBM厚度/nm	病理分期		GS	TA	IF	MCP
组别	n	IgG系膜区沉积	IgM系膜区沉积	IgA系膜区沉积	C3系膜区沉积	C4系膜区沉积	GBM厚度/nm	Ⅰ—Ⅱ期	Ⅲ—Ⅳ期	GS	TA	IF	MCP
正常组	66	4（4，4）	2（2，2）	0（0，0）	2（2，2）	0（0，0）	1 002.27±224.03	60（90.91）	6（9.09）	20（30.30）	20（30.30）	17（25.76）	54（81.82）
超重组	105	4（4，4）	2（2，2）	0（0，0）	2（2，2）	0（0，0）	1 106.67±274.39^a	89（84.76）	16（15.24）	43（41.95）	41（39.05）	40（38.10）	87（82.86）
肥胖组	90	4（4，4）	2（2，2）	0（0，0）	2（2，2）	0（0，0）	1 103.33±237.95^a	75（83.33）	15（16.67）	46（51.11）^a	42（46.67）	42（46.67）^a	81（90.00）
F、χ²或H		0.207	3.085	1.647	5.312	0.697	4.176^＊	1.959		6.826^＊	4.281	7.073^＊	2.675

参数	B	SE	β	t	P
年龄	-0.641	0.056	-0.523	-11.494	<0.001
BUN	-2.276	0.494	-0.218	-4.612	<0.001
anti-PLA2R	-0.010	0.003	-0.130	-3.131	0.002
UTP	-0.580	0.192	-0.134	-3.029	0.003
TA	-4.877	1.581	-0.147	-3.085	0.002