IgA肾病肾小球内C4d沉积与临床病理的联系  

Correlation between Glomerular C4d deposition in IgA nephropathy and clinical pathology

作　　者：张婷[1] 陈波[1] 李凡凡[1] 陈孝倩[1] 黄朝兴[1] 

机构地区：[1]温州医科大学附属第一医院肾内科,浙江温州325015

出　　处：《温州医学院学报》2015年第7期538-541,共4页Journal of Wenzhou Medical College

摘　　要：目的:探讨肾小球内补体C4d沉积是否为Ig A肾病(Ig AN)预后判断的新标志。方法:于2011年1月-2014年5月我院肾活检资料库中,选取78例原发性Ig AN患者,排除合并高血压、糖尿病等系统疾病。对上述病例行肾活检组织免疫组织化学C4d染色。按肾小球内C4d沉积结果分为阳性组和阴性组,回顾性比较2组病例的临床和病理学参数。结果:78例Ig AN,C4d阳性组26例(占33.3%),阴性组52例(占66.7%);所有病例的免疫荧光检查补体C1q均阴性。与C4d阴性组相比,阳性组Ig AN患者较少发生肉眼血尿,高血尿酸(男>488μmol/L、女>363μmol/L)、低估算肾小球滤过率[e GFR<60 m L·min-1·(1.73 m2)-1]和低白蛋白血症(Alb<30 g/L)的发生率较高,血肌酐和24 h尿蛋白定量水平较高,且伴系膜增生(M1)、节段硬化(S1)、肾小管萎缩/间质纤维化(T1)损伤的发生率较高(P<0.05)。而2组间高血Ig A(>400 mg/d L)、低血补体C3(<70 mg/d L)比例及病理上肾小球内皮细胞增生病变(E1)差异均无统计学意义(P>0.05)。logistic回归单因素分析显示,肾小球内C4d沉积与肉眼血尿、24 h尿蛋白定量,低e GFR、低血白蛋白和高血尿酸的比例,及M1、S1和T1相关(均P<0.05)。结论:肾小球内C4d沉积阳性的Ig AN患者临床病理表现较重,提示Ig AN患者疾病的严重程度可能与通过甘露糖凝集素(MBL)途径激活补体相关。Objective： To explore glomerular C4d deposition whether it is a new prognostic factor in IgA nephropathy.Methods： Seventy-eigth patients with the primary IgAN who underwent renal biopsy at our centre were enrolled from January 2011 to May 2014. Patients with diabetes, hypertension, systemic disease, and any type of secondary IgAN were excluded. C4d was detected with immunohistochemical staining in the parafifn embedded renal tissues, using a polyclonal antibody. The cases were divided into positive group and negative group according to the staining of C4d. Then the clinical and pathological parameters were compared between these two groups respectively.Results： Of 78 cases with the primary IgAN, 26 cases （33.3%） were deifned as positive group and 52 cases （66.7%） were deifned as negative group. C1q detections were negative by immu-nolfuorescence in all these cases. Compared with negative group, C4d-positive patients had gross hematuria in less proportion, had higher incidence of hyperuricemia （male〉488 μmol/L; female〉363 μmol/L）, low estimated glomerular ifltration rate [eGFR〈60 mL ？ min-1？ （1.73 m2）-1] and hypoalbuminemia （Alb〈30 g/L） at the time of renal biopsy. C4d-positive patients also had higher levels of serum creatinine and 24-hour urine protein. The proportion of patients with mesangial proliferation （M1）, segmental sclerosis （S1）, tubular atrophy or interstitial ifbrosis （T1） was higher in C4d-positive group according to the Oxford pathologic classiifcation criteria. Between positive group and negative group, there were no signiifcant differences in gender, age, the course of disease, the incidence of high levels of serum IgA （〉400 mg/dl）, low levels serum complement C3 （〈70 mg/dl） and the glomerular endothelial cell hyperplasia （E1） （P〉0.05）. Logistic regression univariate analysis showed that the glo-merular deposition of complement C4d was correlated with gross hematuria, 24-hour urine protein, low eGFR, hypoalbuminemia, hyperu

关 键 词：IGA肾病 补体C4d 甘露糖凝集素途径 

分 类 号：R692[医药卫生—泌尿科学]