儿童原发性IgA肾病131例临床病理特征及预后影响因素分析OA

Objective This study examines the clinical and pathological characteristics of primary IgA nephropathy(IgAN)in children and identifies factors influencing prognosis,while analyzing the dynamic changes in urinary tetraproteins(α1-microglobulin,microalbumin,transferrin,and β2-microglobulin).Methods A retrospective study included 131 pediatric pa-tients with primary IgAN diagnosed by renal biopsy during their hospitalization at our hospital between 2017 and 2024.Baseline de-mographic data,laboratory parameters,pathological findings,and urine protein levels during follow-up were collected.Chi-square tests were used to compare differences in general characteristics and laboratory parameters across different pathological subgroups.Univariate survival analysis was performed using the Kaplan-Meier method,with intergroup comparisons assessed using the Log-rank test.Variables with P＜0.10 in the univariate analysis and clinically significant variables were included in the Cox pro-portional hazards regression model,and independent risk factors were identified using forward stepwise selection.Results Chi-square tests revealed no statistically significant differences in clinical characteristics,including gender,history of upper respiratory tract infection,and season of onset,between the active and inactive pathology groups,or between the low-grade and high-grade Lee classification groups(P＞0.05).There were statistically significant differences between the active and inactive pathology groups in terms of white blood cell count(WBC),complement C3,fibrinogen(FIB),fibrin degradation products(FDP),24-hour urine pro-tein,urinary microalbumin(mAlb),and transferrin(TRF)(P＜0.05).According to the Lee classification,there were statistically significant differences between the low-grade and high-grade groups in indicators such as WBC,serum albumin(sAlb),and immu-noglobulin G(IgG)(P＜0.05).Dynamic analysis of urinary tetraproteins showed that α1-microglobulin(α1-MG)and β2-micro-globulin(β2-MG)peaked at 12 months of follow-up and then gradually declined,while microalbumin(mAlb)and transferrin(TRF)remained stable throughout the follow-up period.The final multivariate Cox regression model showed that age(HR=1.312,95％CI 1.117～1.543,P=0.001),complement C3(HR=0.064,95％CI 0.009～0.450,P=0.006),and the T-score on the MEST-C(HR=28.711,95％CI 2.858～288.392,P=0.004)were independent risk factors influencing the prognosis of pri-mary IgAN in children.Conclusion The clinical manifestations of primary IgAN in children are diverse,changes in α1-MG andβ2-MG levels over time can reflect the trend toward disease remission,while stable markers such as mAlb and TRF can be used for long-term disease monitoring.Advanced age,reduced complement C3 levels,and renal tubular atrophy/interstitial fibrosis(T-score)are independent risk factors for poor prognosis in pediatric patients.In clinical practice,emphasis should be placed on the assessment of the pathological T-score,combined with age and complement C3 levels for risk stratification,to guide individualized treatment.