Abstract:Objective To investigate the correlation between serum levels of Toll-like receptor 4（TLR4）and galectin-3 （Gal-3）of patients with immunoglobulin A（IgA）nephropathy（IgAN）and the severity of the disease，as well as the influencing factors for poor prognosis in IgAN patients. Methods A total of 101 IgAN patients admitted to the Seventh Medical Center of Chinese PLA General Hospital from January 2021 to June 2022 were selected as the experimental group. According to the renal pathological scoring system（MEST-C score），IgAN patients were divided into mild group（n=36），moderate group（n=42）and severe group（n=23）. According to the follow-up results，IgAN patients were divided into good prognosis group（n=69）and poor prognosis group（n=32）. Another 60 healthy subjects during the same period were selected as the control group. Serum samples were obtained from the subjects，and relevant clinical information was collected and sorted out simultaneously. Serum levels of TLR4 and Gal-3 were detected by enzyme-linked immunosorbent assay. Logistic regression was used to analyze the influencing factors of poor prognosis in IgAN patients，and receiver operating characteristic（ROC）curve was used to evaluate the predictive value of TLR4 and Gal-3 for the prognosis of IgAN patients. Results The serum levels of TLR4 and Gal-3 in the experimental group were significantly higher than those in the control group（P<0.05）. The serum levels of TLR4 and Gal-3 in IgAN patients showed an upward trend with the severity of the disease，with the highest level being in the severe group（P<0.05）. Compared with the good prognosis group，the levels of hemoglobin（Hb），albumin（Alb）and estimated glomerular filtration rate（eGFR）in the poor prognosis group were lower，while the levels of serum creatinine（SCr），blood urea nitrogen（BUN），24 h urinary protein quantification，uric acid（UA），serum TLR4 and serum Gal-3 were higher（P<0.05），and the proportion of severe M/E/S/C in the poor prognosis group was higher（P<0.05）. High levels of SCr，24 h urinary protein quantification，TLR4 and Gal-3 were independent risk factors for poor prognosis in IgAN patients，while high level of eGFR was a protective factor（P<0.05）. The area under the curve（AUC）of TLR4 and Gal-3 for poor prognosis was 0.970，with sensitivity and specificity of 87.50% and 94.20%，respectively，which were better than those of single diagnosis（Zcombination-TLR4=3.286，P=0.001；Zcombination-Gal-3=2.669，P=0.008）. Conclusion Serum levels of TLR4 and Gal-3 in IgAN patients are higher than those in healthy people. The combined detection of the two has certain auxiliary diagnostic value for judging increased proteinuria，renal function deterioration and prognosis in IgAN patients.