The relationship between HBV antigens deposition in kidneys and renal prognosis in IgA nephropathy patients infected with HBV

Hepatitis B virus (HBV) is a risk factor for the progression of immunoglobulin A (IgA) nephropathy. The effect of HBV antigens deposition in kidneys and treatment influencing HBV deposition requires further investigation. We analyzed 198 patients with IgAN, including 99 patients with HBV infection and 99 propensity score-matched patients without HBV infection. The primary outcome was a composite of 30% decrease in eGFR from the baseline, kidney failure and all-cause mortality. A Cox proportional hazard model was used to assess the impact of both HBV positive in the serum and HBV antigens deposition in the kidneys on renal outcomes. Among 198 individuals, 27 primary composite outcome events were observed, of which 20 (20%) in the HBV positive group and seven (7%) were in the HBV-negative group. The former had a 2.72-fold increased risk of primary outcome events (adjusted hazard ratio: 2.22; 95% confidence interval: 0.89–5.53). HBV antigens deposition in kidneys increased the risk significantly after adjusting for confounders at the latest follow-up (adjusted hazard ratio: 7.49; 95% confidence interval: 1.00–56.04). Antiviral treatment did not influence the deposition of HBV antigens. HBV antigen deposition in the kidneys, compared with no deposition in the kidneys, was associated with a 7.49-fold increased risk of renal prognosis in patients with IgA nephropathy.

乙型肝炎病毒（Hepatitis B virus, HBV）是IgA肾病（immunoglobulin A nephropathy, IgAN）进展的危险因素。HBV抗原在肾脏中的沉积效应，以及干预措施对HBV沉积的影响，仍有待进一步探究。本研究纳入198例IgAN患者，其中99例合并HBV感染，另外99例为经倾向得分匹配的未感染HBV患者。本研究的主要复合终点为较基线估算肾小球滤过率（estimated glomerular filtration rate, eGFR）下降30%、肾衰竭及全因死亡。采用Cox比例风险模型（Cox proportional hazard model），评估血清HBV阳性与肾脏HBV抗原沉积对肾脏结局的影响。在198例研究对象中，共观察到27例主要复合终点事件：HBV阳性组20例（占比20%），HBV阴性组7例（占比7%）。HBV阳性组发生主要终点事件的风险较对照组升高2.72倍（校正后风险比：2.22；95%置信区间：0.89–5.53）。在校正最新随访时点的混杂因素后，肾脏HBV抗原沉积可显著升高不良结局风险（校正后风险比：7.49；95%置信区间：1.00–56.04）。抗病毒治疗对HBV抗原的沉积无显著影响。与肾脏无HBV抗原沉积的IgAN患者相比，肾脏存在HBV抗原沉积者的肾脏预后风险升高7.49倍。