血清IgA、C_3及IgA/C_3与IgA肾病诊断及病理分级的关系  

The Relationship between the Serum IgA,C_3,IgA/C_3 Levels and IgA Nephropathy

作　　者：汤颖[1] 马小琨[2] 张俊[3] 陈珠江[3] 付莎[1] 徐安平[1] 

机构地区：[1]中山大学附属第二医院肾内科,广东省广州市510120 [2]中山大学附属第三医院肿瘤内科 [3]中山大学附属第三医院肾内科

出　　处：《中华全科医学》2010年第1期17-19,共3页Chinese Journal of General Practice

基　　金：广东省广州市科技攻关计划项目(2004Z3-E0461)

摘　　要：目的比较IgA肾病与非IgA肾病患者血清IgA、C3和IgA/C3水平差异以及观察IgA肾病患者血清IgA、C3及IgA/C3水平与病理Lee氏分级的相关性,探讨血清IgA、C3及IgA/C3水平与IgA肾病的诊断及病理分级的关系。方法中山大学附属第二医院肾内科及中山大学附属第三医院经肾活检穿刺病理检查确诊为原发性IgA肾病126例与非IgA肾病原发性肾小球肾炎患者123例,用散射比浊法检测两组患者的血清IgA、C3水平及按Lee氏分级标准评估IgA肾病病理分级。结果①原发性IgA肾病患者与非IgA肾病原发性肾小球肾炎患者血清IgA水平分别为[(2.91±1.75)vs(2.26±0.93)g/L,P<0.01];血清C3[(0.99±0.28)vs(0.99±0.20)g/L,P>0.05];②原发性IgA肾病患者与非IgA肾病原发性肾小球肾炎患者血清IgA/C3水平分别为[(3.08±1.60)vs(2.34±0.98),P<0.01];③Lee氏分级为Ⅰ和Ⅱ级与Lee氏分级为Ⅲ、Ⅳ、Ⅴ级的IgA肾病患者血清IgA水平分别为[(2.70±1.70)vs(3.06±2.06)g/L,P>0.05];血清C3水平分别为[(1.07±0.30)vs(0.95±0.25)g/L,P<0.05];血清IgA/C3水平分别为[(2.69±1.25)vs(3.32±1.76),P<0.05]。结论血清IgA水平及IgA/C3值可作为鉴别IgA肾病与非IgA肾病的参考指标,C3水平的降低程度与IgA肾病患者病理严重程度密切相关,本研究结果为今后临床借助非创伤性的方法协助诊断IgA肾病与评估IgA肾病患者的肾脏病变程度提供了一种依据。Objective Compare the difference of serum IgA, C3, IgA/C3 levels between the patients with IgA nephropathy （IgAN） and other with non-lgAN and observe the correlation between the serum IgA,C3, IgA/C3 levels and Lee＇s grading system. Furthermore, to explore the relationship between the serum IgA, C3 levels, IgA/C3 ratio and the diagnosis or pathologicalgrading of IgAN. Methods 126 patients with primary. IgAN and 123 patients with other primary glomerulonephritis were diagnosised by renal biopsy in the third affiliated hospital of sun-yetsan university, the levels of serum IgA, C3 were detected with turhidimetric method and the patho-grading was evaluated according to the standard of Lee grading. Results （1）The level of serum IgA between the patients with IgAN and non-IgAN was different（3.08 ± 1.60 vs 2.34 ± 0.98, P 〈 0. 01 ） ; and serum C3 level was not different between two groups（0.99 ± 0.28 vs 0. 99 ± 0.20 g/L, P 〉 0.05 ）. （2）The mean lgA/C3 ratio in the patients with IgAN was significantly higher than that of the primary glomerulonephritis patients with non-IgAN （ 3.08 ± 1.60 vs 2.34 ± 0.98, P 〈 0. 01 ）. （3）The serum IgA level of the patients with Lee Ⅰ and Ⅱ grade was not higher than the patients with Lee Ⅲ, Ⅳ, Ⅴ grade （ 2.70 ± 1.70 vs 3.06 ± 2.06 g/L,P 〉 0.05 ） ; but serum C3 level was significantly different between the patients with Lee Ⅰ , Ⅱ grade and Lee Ⅲ, Ⅳ, Ⅴ grade（ 1.07± 0.30 vs 0.95 ± 0, 25 g/L, P 〈 0.05 ）, and so was IgA/C3 ratio in two groups （ 2.69 ± 1.25 vs 3.32 ± 1.76,P 〈 0.05 ）. Conclusion The serum IgA level and IgA/C3 ratio could be served as a reference indexes for identifying lgAN and non-lgAN ; the lowering degree of serum C3 level appeared to be close correlation with severity of pathology of patients with IgAN. Our study provided a foundation for diagnosing IgAN and evaluating the histological severity of IgAN in clinical apply with non-invasive methods in future.

关 键 词：血清IGA 血清C3 血清IgA/C3比值 病理分级 IGA肾病 

分 类 号：R692[医药卫生—泌尿科学] R446.62[医药卫生—外科学]