C3与IgA肾病临床及病理的关系  

The relationship between complement 3 and IgAN in clinic and pathology

作　　者：吴萍[1] 邹军[1] 陈舜杰[1] 周波[1] 蒋更如[1] 

机构地区：[1]上海交通大学医学院附属新华医院肾脏内科,上海200092

出　　处：《中国医师杂志》2015年第6期883-887,共5页Journal of Chinese Physician

摘　　要：目的 通过分析血补体3（C3）与免疫球蛋白A肾病（IgAN）临床生化指标及组织中C3沉积与牛津病理分型中主要参考指标间关系探讨C3在IgAN中的作用.方法 纳入2000年1月至2013年12月期间在本院经皮肾穿刺活检明确诊断为原发性IgAN的患者558例,以血C3≥0.9 g/L为正常组,以血C3＜ 0.9 g/L为补体降低组,回顾性分析患者的临床资料与病理资料.结果 （1）血C3正常组血肌酐（Scr）、血尿素氮（BUN）、估算的肾小球滤过率（eGFR）分别为（100.92±105.31）μmol/L,（5.69±2.88） mmol/L,（119.54±58.12）ml/（min＆#183;1.73 m^2）;而血C3降低组血Scr、血BUN、eGFR分别为（157.58±208.39） μmoL/L,（7.69±5.90） mmol/L,（98.97±59.07） ml/（min＆#183;1.73 m^2）,两组差异有统计学意义（t=-2.283、-2.81、2.779;P＜0.05、P＜0.01）.同时血C3正常组及降低组的血IgA、体质量、体质量指数、总胆固醇（CHO）、甘油三酯（TG）、血IgA/血C3比值、血白蛋白（ALB）差异有统计学意义（P＜0.05、P＜0.01）.（2）血C3正常组和降低组在牛津病理分型中评判预后的指标系膜细胞增殖（M）、毛细血管内皮细胞增生（E）、肾小球硬化或粘连（S）、肾小管萎缩或间质纤维化（T）及各类免疫球蛋白沉积中差异无统计学意义（P＞0.05）;但C3沉积阴性亚组与C3沉积2＋和3＋亚组的血C3间差异有统计学意义（P=0.013、P=0.006）.（3）C3组织中沉积与牛津病理分型中M、E、S、T有关（x2=50.782、35.141、21.105、30.182,P均＜0.01）.结论 伴有血C3降低的IgA肾病患者有着较为严重的临床表现,系膜区C3沉积与严重的病理损害相关。Objectives By Oxford pathological classification and analysis of circulating complement complement 3 （C3）,renal C3 deposition,and clinical laboratory tests,we discussed the correlation between complement C3 and immunoglobin A nephropathy （IgAN） in pathogenesis.Methods A retrospective study of 558 IgAN cases at Xinhua Hospital from January of 2000 through December of 2013 was performed.All 558 IgAN diagnoses were made and confirmed by renal needle biopsy.Results Compared to patients who had circulating C3 〈 0.9,patients with circulating C3 level 〉 0.9 showed statistically significant decreases in serum creatinine [（100.92 ± 105.31） μmol/L vs （157.58 ± 208.39） μmol/L,t =-2.283,P =0.025],blood urea nitrogen [（5.69 ± 2.88） mmol/L vs （7.69 ± 5.90） mmoL/L,t =-2.81,P =0.006];besides,other parameters like IgA,body weight,body mass index （BMI）,cholesterol,triglyceride,serum IgA/C3 ratio,albumin,and estimated glomeruli filtrate rate （eGFR） also presented statistically significant differences between two patient groups;no statistically significant differences were observed between two groups in glomerular mesangial cell proliferation,capillary endothelial proliferation,segmental glomerular sclerosis or adhesions,renal tubule atrophy,tubulointerstitial fibrosis,and formation of glomerular crescent;meanwhile,no statistically significant differences were observed between two groups in mesangial depositions of IgA,IgG,IgM,and complement C3;meanwhile the blood level of C3 between C3 deposition negative group,deposition 2 ＋ and 3 ＋ subgroup showed statistically significant differences （2.493 and 2.782;0.013 and 0.006）,nevertheless,prognostic indices in Oxford classification,such as mesangial cell proliferation,capillary endothelial proliferation,segmental glomerular sclerosis or adhesions,renal tubule atrophy and tubulointerstitial fibrosis,were also statistically different between two patient groups （Pearson Square test result was 50.782,35.141,21.105,30.182,respectively;P 〈0

关 键 词：补体C3/代谢 肾小球肾炎 IGA/代谢/病理学 

分 类 号：R692[医药卫生—泌尿科学]