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郑州大学第一附属医院肾脏内科/郑州大学肾脏病研究所 河南 郑州 450000
Received:29 August 2024,
Published:25 October 2025
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孙帅刚,翟亚玲,盛晓笑等.双样本孟德尔随机化分析肥胖相关指标与免疫球蛋白A肾病的因果关联[J].武汉大学学报(医学版),2025,46(10):1293-1300.
SUN Shuaigang,ZHAI Yaling,SHENG Xiaoxiao,et al.Two⁃sample Mendelian randomization analysis of the causal relationship between obesity⁃related factors and immunoglobulin A nephropathy[J].Medical Journal of Wuhan University,2025,46(10):1293-1300.
孙帅刚,翟亚玲,盛晓笑等.双样本孟德尔随机化分析肥胖相关指标与免疫球蛋白A肾病的因果关联[J].武汉大学学报(医学版),2025,46(10):1293-1300. DOI: 10.14188/j.1671-8852.2024.0655.
SUN Shuaigang,ZHAI Yaling,SHENG Xiaoxiao,et al.Two⁃sample Mendelian randomization analysis of the causal relationship between obesity⁃related factors and immunoglobulin A nephropathy[J].Medical Journal of Wuhan University,2025,46(10):1293-1300. DOI: 10.14188/j.1671-8852.2024.0655.
目的
2
基于孟德尔随机化(MR)分析探讨肥胖相关指标与免疫球蛋白A肾病(IgAN)间潜在的因果关联。
方法
2
提取体质量指数(BMI)、全身脂肪量、体脂率、躯干脂肪量、躯干脂肪率、腰围、臀围、腰臀比和IgAN的大规模全基因组关联研究(GWAS)的汇总数据,以逆方差加权法(IVW)作为主要结果进行双向MR分析。通过Cochran's
Q
检验、MR⁃Egger截距检验、MR⁃PRESS
O检验和留一法证实结果的准确性和稳定性。
结果
2
基因预测的BMI(
OR
=1.202
95%
CI
:1.121~1.288
P
=2.009×10
-7
)、全身脂肪量(
OR
=1.215
95%
CI
:1.129~1.307
P
=1.827×10
-7
)、体脂率(
OR
=1.144
95%
CI
:1.023~1.279
P
=1.864×10
-2
)、躯干脂肪量(
OR
=1.227
95%
CI
:1.136~1.326
P
=1.994×10
-7
)、躯干脂肪率(
OR
=1.113
95%
CI
:
1
.011~1.227
P
=0.030)、腰围(
OR
=1.255
95%
CI
:1.148~1.371
P
=5.712×10
-7
)、臀围(
OR
=1.175
95%
CI
:1.085~1.274
P
=7.997×10
-5
)与发生IgAN的风险呈正相关,但尚无证据显示腰臀比(
OR
=1.081
95%
CI
:0.855~1.368
P
=0.516)与IgAN之间存在可靠的因果关系。这些结果在一系列敏感性分析中是可靠的。此外,反向MR分析显示,IgAN可能不会增加肥胖的风险。
结论
2
肥胖会增加罹患IgAN的风险,预防肥胖可能是降低IgAN风险的重要策略。
Objective
2
To investigate the potential causal association between obesity⁃related factors and immunoglobulin A nephropathy (IgAN) based on Mendelian randomization (MR).
Methods
2
The summary⁃level data of body mass index (BMI)
whole⁃body fat mass
body fat percentage
trunk fat mass
trunk fat percentage
waist circumference
hip circumference
waist⁃to⁃hip ratio and IgAN from large⁃scale Genome⁃Wide Association Studies (GWAS) of European ancestry were extracted to conduct bidirectional MR analysis using the inverse variance weighted (IVW) method as primary results. The Cochran's
Q
test
MR⁃Egger regression intercept test
MR⁃PRESSO
and leave⁃one⁃out sensitivity analysis were conducted to confirm the accuracy and robustness of results.
Results
2
The evidence provided by primary MR analysis showed tha
t genetically predicted BMI (
OR
=1.202
95%
CI
: 1.121⁃1.227
P
=2.009×10
-7
)
whole⁃body fat mass (
OR
=1.215
95%
CI
:1.129⁃1.307
P
=1.827×10
-7
)
body fat percentage (
OR
=1.144
95%
CI
:1.023⁃1.279
P
=1.864×10
-2
)
trunk fat mass (
OR
=1.228
95%
CI
: 1.136⁃1.326
P
=1.994×10
-7
)
trunk fat percentage (
OR
=1.113
95%
CI
: 1.011⁃1.227
P
=0.030)
waist circumference (
OR
=1.255
95%
CI
: 1.148⁃1.371
P
=5.712×10
-7
)
hip circumference (
OR
=1.175
95%
CI
: 1.085⁃1.274
P
=7.997×10
-5
) was positive associated with the risk of developing IgAN
but no evidence revealed a reliable casual association between waist⁃to⁃hip ratio (
OR
=1.081
95%
CI
: 0.855⁃1.368
P
=0.516) and IgAN. These results were robust to a series of sensitivity analyses. In addition
the reverse MR analysis showed that IgAN might not cause obesity.
Conclusion
2
Obesity may increase the risk of developing IgAN
and its prevention could be an important strategy to reduce this risk.
PETROU D , KALOGEROPOULOS P , LIAPIS G , et al . IgA nephropathy: Current treatment and new insights [J ] . Antibodies , 2023 , 12 ( 2 ): 40 .
GENTILE M , SANCHEZ⁃RUSSO L , RIELLA L V , et al . Immune abnormalities in IgA nephropathy [J ] . Clin Kidney J , 2023 , 16 ( 7 ): 1059 ⁃ 1070 .
NATALE P , PALMER S C , RUOSPO M , et al . Immunosuppressive agents for treating IgA nephropathy [J ] . Cochrane Database Syst Rev , 2020 , 3 ( 3 ): CD003965 .
Risk Factor Collaboration (NCD⁃RisC) . Worldwide trends in body⁃mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2 416 population⁃based measurement studies in 128·9 million children, adolescents, and adults [J ] . Lancet , 2017 , 390 ( 10113 ): 2627 ⁃ 2642 .
KIM T B , AHN S Y , OH J , et al . The impact of obesity on kidney disease: Observational cohort study analyzing 14 492 kidney biopsy cases [J ] . J Korean Med Sci , 2024 , 39 ( 3 ): e12 .
Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration , LU Y , HAJIFATHALIAN K , et al . Metabolic mediators of the effects of body⁃mass index, overweight, and obesity on coronary heart disease and stroke: A pooled analysis of 97 prospective cohorts with 1.8 million participants [J ] . Lancet , 2014 , 383 ( 9921 ): 970 ⁃ 983 .
MEIGS J B , WILSON P W F , FOX C S , et al . Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease [J ] . J Clin Endocrinol Metab , 2006 , 91 ( 8 ): 2906 ⁃ 2912 .
GAROFALO C , BORRELLI S , MINUTOLO R , et al . A systematic review and meta⁃analysis suggests obesity predicts onset of chronic kidney disease in the general population [J ] . Kidney Int , 2017 , 91 ( 5 ): 1224 ⁃ 1235 .
PANWAR B , HANKS L J , TANNER R M , et al . Obesity, metabolic health, and the risk of end⁃stage renal disease [J ] . Kidney Int , 2015 , 87 ( 6 ): 1216 ⁃ 1222 .
HONG Y A , MIN J W , HA M A , et al . The impact of obesity on the severity of clinicopathologic parameters in patients with IgA nephropathy [J ] . J Clin Med , 2020 , 9 ( 9 ): 2824 .
WANG S Q , QIN A Y , DONG L Q , et al . Association of obesity with the development of end stage renal disease in IgA nephropathy patients [J ] . Front Endocrinol , 2023 , 14 : 1094534 .
MESTECKY J , NOVAK J , MOLDOVEANU Z , et al . IgA nephropathy enigma [J ] . Clin Immunol , 2016 , 172 : 72 ⁃ 77 .
LAI K N . Pathogenesis of IgA nephropathy [J ] . Nat Rev Nephrol , 2012 , 8 ( 5 ): 275 ⁃ 283 .
KNOPPOVA B , REILY C , MAILLARD N , et al . The origin and activities of IgA1⁃containing immune complexes in IgA nephropathy [J ] . Front Immunol , 2016 , 7 : 117 .
ESPOSITO K , PONTILLO A , DI PALO C , et al . Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: A randomized trial [J ] . JAMA , 2003 , 289 ( 14 ): 1799 ⁃ 1804 .
VISSER M , BOUTER L M , MCQUILLAN G M , et al . Low⁃grade systemic inflammation in overweight children [J ] . Pediatrics , 2001 , 107 ( 1 ): E13 .
TIMPSON N J , NORDESTGAARD B G , HARBORD R M , et al . C⁃reactive protein levels and body mass index: Elucidating direction of causation through reciprocal Mendelian randomization [J ] . Int J Obes (Lond) , 2011 , 35 ( 2 ): 300 ⁃ 308 .
SMITH G D , EBRAHIM S . 'Mendelian randomization': Can genetic epidemiology contribute to understanding environmental determinants of disease? [J ] . Int J Epidemiol , 2003 , 32 ( 1 ): 1 ⁃ 22 .
BOEF A G C , DEKKERS O M , LE CESSIE S . Mendelian randomization studies: A review of the approaches used and the quality of reporting [J ] . Int J Epidemiol , 2015 , 44 ( 2 ): 496 ⁃ 511 .
ZOU X L , WANG S , WANG L Y , et al . Childhood obesity and risk of stroke: A Mendelian randomisation analysis [J ] . Front Genet , 2021 , 12 : 727475 .
XIE J R , HUANG H K , LIU Z N , et al . The associations between modifiable risk factors and nonalcoholic fatty liver disease:A comprehensive Mendelian randomization study [J ] . Hepatology , 2023 , 77 ( 3 ): 949 ⁃ 964 .
BURGESS S , BUTTERWORTH A , THOMPSON S G . Mendelian randomization analysis with multiple genetic variants using summarized data [J ] . Genet Epidemiol , 2013 , 37 ( 7 ): 658 ⁃ 665 .
BONNET F , DEPRELE C , SASSOLAS A , et al . Excessive body weight as a new independent risk factor for clinical and pathological progression in primary IgA nephritis [J ] . Am J Kidney Dis , 2001 , 37 ( 4 ): 720 ⁃ 727 .
KATAOKA H , OHARA M , SHIBUI K , et al . Overweight and obesity accelerate the progression of IgA nephropathy: Prognostic utility of a combination of BMI and histopathological parameters [J ] . Clin Exp Nephrol , 2012 , 16 ( 5 ): 706 ⁃ 712 .
KESSLER C . Pathophysiology of obesity [J ] . Nurs Clin N Am , 2021 , 56 ( 4 ): 465 ⁃ 478 .
TORTAJADA A , GUTIERREZ E , PICKERING M C , et al . The role of complement in IgA nephropathy [J ] . Mol Immunol , 2019 , 114 : 123 ⁃ 132 .
GABRIELSSON B G , JOHANSSON J M , LÖNN M , et al . High expression of complement components in omental adipose tissue in obese men [J ] . Obes Res , 2003 , 11 ( 6 ): 699 ⁃ 708 .
WLAZLO N , VAN GREEVENBROEK M M J , FERREIRA I , et al . Low⁃grade inflammation and insulin resistance independently explain substantial parts of the association between body fat and serum C3: The CODAM study [J ] . Metabolism , 2012 , 61 ( 12 ): 1787 ⁃ 1796 .
UNAMUNO X , GÓMEZ⁃AMBROSI J , RODRÍGUEZ A , et al . Adipokine dysregulation and adipose tissue inflammation in human obesity [J ] . Eur J Clin Invest , 2018 , 48 ( 9 ): e12997 .
MYERS M G , LEIBEL R L , SEELEY R J , et al . Obesity and leptin resistance: Distinguishing cause from effect [J ] . Trends Endocrinol Metab , 2010 , 21 ( 11 ): 643 ⁃ 651 .
WOLF G , HAMANN A , HAN D C , et al . Leptin stimulates proliferation and TGF⁃beta expression in renal glomerular endothelial cells: Potential role in glomerulosclerosis[seecomments [J ] . Kidney Int , 1999 , 56 ( 3 ): 860 ⁃ 872 .
SERRA A , ROMERO R , LOPEZ D , et al . Renal injury in the extremely obese patients with normal renal function [J ] . Kidney Int , 2008 , 73 ( 8 ): 947 ⁃ 955 .
HOLLAND W L , MILLER R A , WANG Z V , et al . Receptor⁃mediated activation of ceramidase activity initiates the pleiotropic actions of adiponectin [J ] . Nat Med , 2011 , 17 ( 1 ): 55 ⁃ 63 .
SONG H J , CHAN J , ROVIN B H . Induction of chemokine expression by adiponectin in vitro is isoform dependent [J ] . Transl Res , 2009 , 154 ( 1 ): 18 ⁃ 26 .
SHARMA K , RAMACHANDRARAO S , QIU G , et al . Adiponectin regulates albuminuria and podocyte function in mice [J ] . J Clin Invest , 2008 , 118 ( 5 ): 1645 ⁃ 1656 .
LAI K N , TANG S C W , SCHENA F P , et al . IgA nephropathy [J ] . Nat Rev Dis Primers , 2016 , 2 : 16001 .
INOUE T , SUGIYAMA H , KITAGAWA M , et al . Suppression of adiponectin by aberrantly glycosylated IgA1 in glomerular mesangial cells in vitro and in vivo [J ] . PLoS One , 2012 , 7 ( 3 ): e33965 .
SATO M , HAIZUKA H , ASAKURA H . Relationship between serum IgA levels and CD4 subsets in IgA nephropathy [J ] . Nephron , 1994 , 68 ( 1 ): 20 ⁃ 24 .
RUSZKOWSKI J , LISOWSKA K A , PINDEL M , et al . T cells in IgA nephropathy: Role in pathogenesis, clinical significance and potential therapeutic target [J ] . Clin Exp Nephrol , 2019 , 23 ( 3 ): 291 ⁃ 303 .
SURENDAR J , FROHBERGER S J , KARUNAKARAN I , et al . Adiponectin limits IFN⁃γ and IL⁃17 producing CD4 T cells in obesity by restraining cell intrinsic glycolysis [J ] . Front Immunol , 2019 , 10 : 2555 .
GALGANI M , PROCACCINI C , DE ROSA V , et al . Leptin modulates the survival of autoreactive CD4 + T cells through the nutrient/energy⁃sensing mammalian target of rapamycin signaling pathway [J ] . J Immunol , 2010 , 185 ( 12 ): 7474 ⁃ 7479 .
PARIS S , EKEANYANWU R , JIANG Y W , et al . Obesity and its effects on the esophageal mucosal barrier [J ] . Am J Physiol Gastrointest Liver Physiol , 2021 , 321 ( 3 ): G335 ⁃G343.
COPPO R . The intestine⁃renal connection in IgA nephropathy [J ] . Nephrol Dial Transplant , 2015 , 30 ( 3 ): 360 ⁃ 366 .
FELLSTRÖM B C , BARRATT J , COOK H , et al . Targeted⁃release budesonide versus placebo in patients with IgA nephropathy (NEFIGAN): A double⁃blind, randomised, placebo⁃controlled phase 2b trial [J ] . Lancet , 2017 , 389 ( 10084 ): 2117 ⁃ 2127 .
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