Background

IgA nephropathy (IgAN) is a chronic immuno-inflammatory progressive disease. Several systemic inflammatory indicators, mainly the neutrophil-to-lymphocyte ratio (NLR), are regarded as valuable markers for many diseases, such as IgA vasculitis and chronic kidney disease. Here, we investigated multiple peripheral blood indicators in a large IgAN registry with regular follow-up to evaluate their effects on IgAN phenotypes and progression.

Methods

Totally, 1151 IgAN patients with regular follow-up, and 251 healthy volunteers were enrolled. Complete blood count test results, including counts of white blood cells (WBC), neutrophils (NE), lymphocyte (LY), and platelets (PLT), were collected from medical records. Then, NLR and PLR were calculated.

Results

IgAN patients presented with increased WBC, NE, NLR and PLR levels and decreased LY levels compared with controls. In univariate survival analysis, WBC, NE and NLR showed significant associations with IgAN progression, and NLR had a higher area under the ROC curves than NE and WBC. When adjusted for well-known risk factors, NLR remained an independent risk factor for poor renal outcome in IgAN patients and performed better than NE. By using NLR 2.40 as cutoff point, IgAN patients were divided into two groups. IgAN patients in the high NLR group presented with lower eGFR, higher proteinuria, higher incidence of hypertension, and more severe pathological lesions, as well as lower event-free renal survival rate.

Conclusions

We found patients with IgAN had elevated NLR levels than healthy controls, and the easily available NLR in clinical practice could serve as an independent risk factor for IgAN progression.

中文翻译：

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中性粒细胞与淋巴细胞之比作为IgA肾病预后不良的独立炎症指标。

背景

IgA肾病（IgAN）是一种慢性免疫炎性进行性疾病。几种全身性炎症指标，主要是中性粒细胞与淋巴细胞之比（NLR），被认为是许多疾病（例如IgA血管炎和慢性肾脏病）的有价值的标志。在这里，我们通过定期随访调查了大型IgAN注册中心中的多个外周血指标，以评估其对IgAN表型和进展的影响。

方法

共有1151名IgAN患者接受了定期随访，并纳入了251名健康志愿者。从医疗记录中收集了全血细胞计数测试结果，包括白细胞（WBC），中性粒细胞（NE），淋巴细胞（LY）和血小板（PLT）的计数。然后，计算了NLR和PLR。

结果

与对照组相比，IgAN患者的WBC，NE，NLR和PLR水平升高，而LY水平降低。在单变量生存分析中，WBC，NE和NLR与IgAN进展密切相关，并且ROC曲线下NLR的面积大于NE和WBC。调整众所周知的危险因素后，NLR仍是IgAN患者肾预后不良的独立危险因素，并且表现优于NE。以NLR 2.40为临界点，将IgAN患者分为两组。高NLR组的IgAN患者表现出较低的eGFR，较高的蛋白尿，较高的高血压发生率和更严重的病理病变，以及较低的无事件肾存活率。

结论

我们发现IgAN患者的NLR水平高于健康对照者，临床实践中易于获得的NLR可作为IgAN进展的独立危险因素。