血清C1q抗体对评价狼疮肾炎活动性及疗效的临床意义  

Significance of serum anti-C1q Ab in evaluation of lupus nephritis activity and its curative effects of pharmacotherapy on lupus nephritis

作　　者：蔡小燕[1] 杨岫岩[2] 陈小辉[3] 梁柳琴[2] 关明媚[1] 秦曙光[4] 傅君舟[4] 

机构地区：[1]广州市第一人民医院风湿科,510180 [2]中山大学附属第一医院风湿科 [3]广州市第一人民医院检验科,510180 [4]广州市第一人民医院肾内科,510180

出　　处：《中华医学杂志》2004年第17期1436-1439,共4页National Medical Journal of China

摘　　要：目的　探讨血清C1q抗体对狼疮肾炎活动性及疗效的评价。 方法　用酶联免疫吸附实验 (ELISA)检测 75例活动期狼疮肾炎患者血清中的C1q抗体 ,对 31例狼疮患者作了肾穿刺活检。分析C1q抗体与狼疮肾炎活动性、肾组织病理改变及实验室参数的相关性。并对全部病例进行随访 ,分析血清C1q抗体及治疗后的变化对狼疮肾炎疗效的影响。 结果　 5 5例 (73 3% )狼疮肾炎患者血清C1q抗体阳性 ,抗体水平 92U/ml± 4 1U/ml;血清C1q抗体水平与狼疮肾炎临床活动指数、尿蛋白含量以及双链DNA(ds DNA)抗体滴度呈正相关 ,与补体C3、C4水平呈负相关 ;血清C1q抗体水平与肾脏病理改变的活动指数呈正相关 ;COX回归多因素分析显示 ,血清C1q抗体及治疗后的C1q抗体水平与狼疮肾炎尿蛋白转阴存在相关性 ,后者更有意义。结论　C1q抗体不仅与狼疮肾炎活动性相关 ,而且在一定程度上反映肾脏病变程度 ,监测治疗后抗体水平的变化可以为评价疗效及指导临床治疗提供重要依据。Objective To investigate the significance of serum anti-C1q Ab of evaluation of lupus nephritis activity and its curative effects of cyclophophamide therapy on lupus nephritis (LN) . Methods The level of serum anti-C1q antibody of 75 patients with LN was examined by enzyme-linked immunosorbent assay (ELISA) of the 75 patients the incipient cases had never received corticosteroid and immunosuppressant and the recurrent cases had stopped the immunosuppressant treatment for more than 3 months and were treated, if so, with prednisone with the dosage ≤10 mg/d. Thirty-one patients underwent renal biopsy. The patients underwent treatment of cyclophophamide. The relationships between serum anti-C1q Ab level and lupus nephritis activity, renal pathohistology, as well as laboratory parameters were analyzed, followed by further regular follow-up to investigate its influence to the curative effect. Results Fifty-five of the 75 patients (73.3%) were anti-C1q Ab positive with the level of (92 U/ml±41 U/ml). The mean time of conversion of urinary protein into negative was 9 months in the positive C1q positive group and 6 months in the C1q negative group. One year after, 25% of those with positive C1q antibody failed to convert into urinary protein negative, and 90% of those with negative C1q antibody converted into urinary protein negative. One year after, 32% of those whose serum C1q antibody remained positive 1 month after the treatment failed to convert into urinary protein negative, and 91% of those whose serum C1q antibody remained positive 1 month after the treatment converted into urinary protein negative. The serum anti-C1q Ab level was positively correlated with the lupus nephritis clinical active index, proteinuria, and titer of anti-dsDNA, and was negatively correlated with the levels of serum C3 and C4. Renal biopsies showed a positive correlation between the serum anti-C1q Ab level and the activity index of renal pathohistology. Multivariate analysis showed that the serum anti-C1q Ab level after treatmen

关 键 词：血清C1q抗体 狼疮肾炎 活动性 比例危险度模型 肾脏病 

分 类 号：R593.242[医药卫生—内科学]