狼疮肾炎患者血清H因子水平膜攻击复合物变化及其意义  

Clinical significance of serum memb rane attack complex and complete factor H level in lupus nephritis

作　　者：孙亚萍[1] 陈春[1] 贾乐文[1] 

机构地区：[1]大连医科大学附属第一医院肾内科,116011

出　　处：《中华风湿病学杂志》2015年第9期614-618,共5页Chinese Journal of Rheumatology

基　　金：大连市科技计划项目（2012E15SF173）

摘　　要：目的 探讨膜攻击复合物（MAC）和H因子在LN中的临床意义.方法 应用ELISA检测30例LN患者与25名健康对照组血清中MAC和H因子的浓度,并分析比较其在LN患者血清中的变化及相关实验室指标的关系.采用t检验、x2检验和Spearman相关性分析进行统计学分析.结果 ①LN患者血清MAC的浓度高于健康对照组[（74± 100） μg/ml与（18±8）μg/ml,Z=2.777,P＜0.05];活动组MAC浓度高于非活动组[（92±53） μg/ml与（32±23） μg/ml,t=3.661,P＜0.05];②LN患者血清H因子的浓度低于健康对照组[（311±146） ng/ml与（412±76） ng/ml,Z=-3.139,P＜0.05];活动组H因子低于非活动组[（282±11） ng/ml与（330±20） ng/ml,t=-8.333,P＜0.05];③LN患者血清MAC水平与补体C3呈负相关（r=-0.603,P＜0.05）,与抗dsDNA抗体、尿蛋白定量（24 h）、英国SLE评估小组（BILAG）积分、SLEDAI积分呈正相关（r值分别为0.481,0.694,0.709,0.613,P均＜0.05）;④LN患者血清H因子水平与补体C3呈正相关（r=0.568,P＜0.05）,与抗dsDNA抗体、尿蛋白定量（24 h）、BILAG积分、SLEDAI积分呈负相关（r值分别为-0.443,-0.485,-0.639,-0.597,P均＜0.05）.⑤LN患者活动组18例肾活检肾脏病理结果病变以肾小管上皮细胞变性及肾小球细胞增生为主;非活动组11例肾活检病理结果病变以系膜细胞增生为主.结论 血清MAC升高、H因子减少通过补体经典途径、旁路途径加速LN的发展,同时与LN全身活动性及肾脏病理改变密切相关,可作为生物标志物反映LN活动性,也对肾脏病理活动性病变的生物学诊断价值提供了新的线索.Objective To discuss the clinical significance of serum membrane attack complex （MAC）and complete factor H （CFH） level in lupus nephritis （LN）.Methods Indirect enzyme-linked immunosorbent assay was used to detect MAC and CFH respectively in 30 LN patients and 25 healthy controls.At the same time other laboratory indexes were detected and the relation between the change of serum MAC and CFH levels and other indexes were analyzed.The data were analyzed by t test,Chi-square test and Spearman correlation analysis.Results The level of serum MAC in LN group was significantly higher than that in healthy controls and non-active group [（74±100）] vs （18±8） μg/ml,Z=2.777,P〈0.05;（92±53） μg/ml vs （32±23） μg/ml,t=3.661,P〈0.05].The level of serum CFH in the LN group was lower than that in healthy controls and non-active group [（311±146） ng/ml vs （412±76） ng/ml,Z=-3.139,P〈0.05;（282±11） ng/ml vs （330±20） ng/ml,t=-8.333,P〈0.05].The serum levels of MAC in the LN group showed negative correlation with the level of C3 （r=-0.603,P〈0.05）,and showed positive correlation with dsDNA,24 hours urine protein quantification,as well as the scores of SLEDAI and BILAG （rdsDNA=0.481,P〈0.05;r24 hpro=0.694,P〈0.05;rBILAG=0.709,P〈0.05;rSLEDAI=0.613,P〈0.05）.The levels of serum CFH in LN group was positively correlated with the level of C3 （r=0.568,P〈0.05）,while negatively correlated with dsDNA,24 hours urine protein quantification,as well as the scores of SLEDAI and BILAG （rdsDNA=-0.443,P〈0.05;r24hpro=-0.485,P〈0.05,rBILAG=-0.639,P〈0.05,rSLEDAI=-0.597,P〈0.05）.The pathology of lupus nephritis in the active group of 18 patients showed proliferation of glomerular cells and degenerated tubular epithelial cells,and those in the non-active group was mainly the proliferation of mesangial cells.Conclusion In summary,the increase of MAC and decrease CFH level accelerates the development of lupus nephritis,while they are positively correlated with the change of pat

关 键 词：狼疮肾炎 补体系统 膜攻击复合物 H因子 

分 类 号：R593.242[医药卫生—内科学]