血清IgA/C3和病理C3沉积对IgA肾病患者临床预后的影响  

Effect of serum IgA/C3 and glomerular C3 staining on clinical prognosis in patients with IgA nephropathy

作　　者：裴改琴 秦嫒雅 王思清 谭丽 唐怡[1] 秦伟[1] Pei Gaiqin;Qin Aiya;Wang Siqing;Tan Li;Tang Yi;Qin Wei(Department of Nephrology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院肾脏内科,成都610041

出　　处：《中华医学杂志》2020年第30期2372-2377,共6页National Medical Journal of China

摘　　要：目的探讨IgA肾病(IgAN)患者血清IgA/C3比值和病理C3沉积与临床预后的关系。方法纳入2007年1月1日至2016年12月30日于四川大学华西医院经皮肾穿刺活检确诊的原发性IgAN患者519例,根据肾穿刺活检时血清学及病理结果将患者分为4组:A组(151例)血清IgA/C3比值≥3.046(中位数)且肾小球C3染色≥2;B组(109例)血清IgA/C3比值≥3.046且肾小球C3染色<2;C组(119例)血清IgA/C3比值<3.046且肾小球C3染色≥2;D组(140例)血清IgA/C3比值<3.046且肾小球C3染色<2。收集患者临床资料、病理特征、随访终点[估算肾小球滤过率(eGFR)下降≥50%和(或)终末期肾脏病(ESRD)],分析各组患者的临床预后及相关因素。结果 519例患者中男298例(57.4%),年龄(33.6±10.9)岁,随访(43.4±21.6)个月。A、B、C、D组的完全缓解+部分缓解率分别为74.2%(112/151)、74.3%(81/109)、72.3%(86/119)、81.4%(114/140),A组达到ESRD的患者比例最高(14.6%与9.2%、13.4%、8.6%);A组、C组达到复合终点的患者比例高于B、D两组(15.2%、16.0与8.3%、7.9%)。Kaplan-Meier生存曲线显示A组的80个月肾脏存活率为84.8%,低于B组、D组的91.7%、92.1%,但是与B组比较差异无统计学意义(PAB=0.085;PAD=0.028);A组与C组肾脏存活率相近,差异无统计学意义(84.8%比84.0%,P=0.896)。多因素Cox回归分析提示高血压(HR=2.753,95%CI:1.452-5.217,P=0.002)、血肌酐(HR=1.011,95%CI:1.008-1.014,P<0.001)和肾小管萎缩或肾间质纤维化(T1/T2)(HR=6.595,95%CI:3.107-13.999,P<0.001)是肾脏存活的不良预后因素。结论血清IgA/C3和肾小球C3染色可以帮助预测IgAN的治疗效果和临床预后。Objective To investigate the effects of serum immunoglobulin A/complement factor 3(IgA/C3)ratio and glomerular C3 staining on clinical prognosis in patients with IgA nephropathy.Methods From January 1st,2007 to December 30th,2016,a total of 519 patients with biopsy-proven IgA nephropathy(IgAN)in West China Hospital were retrospectively reviewed and divided into four groups based on serum IgA/C3 ratio and glomerular C3 staining:group A with IgA/C3 ratio≥3.046(median)and glomerular C3 staining≥2(n=151),group B with IgA/C3 ratio≥3.046 and glomerular C3 staining<2(n=109),group C with IgA/C3 ratio<3.046 and glomerular C3 staining≥2(n=119),and group D with IgA/C3 ratio<3.046 and glomerular C3 staining<2(n=140).Clinical data,pathological characteristics and the primary endpoint[≥50%decline in estimated glomerular filtration rate(eGFR)and/or end-stage renal disease(ESRD)]were collected.Clinical prognosis and relevant risk factors were analyzed among the four groups.Results Totally,519 patients(298 males,57.4%)with an average age of(33.6±10.9)years were recruited and followed up for(43.4±21.6)months.The rate of complete remission plus partial remission was 74.2%(112/151),74.3%(81/109),72.3%(86/119),81.4%(114/140)in group A,B,C,D,respectively.Meanwhile,The rate of ESRD was highest in group A(14.6%vs 9.2%,13.4%,8.6%).Renal outcome(patients reached the endpoint)was worse in group A and C compared with group B and D(15.2%,16.0 vs 8.3%,7.9%).Moreover,80-month renal survival rate was significantly worse in group A(84.8%)than that in group B and D(91.7%and 92.1%),but no statistical significant difference was found between group A and B(PAB=0.085;PAD=0.028).There was no significant difference of renal survival rate between group A and C(84.8%vs 84.0%,P=0.896).Multivariate Cox model showed that hypertension(HR=2.753,95%CI:1.452-5.217,P=0.002),serum creatinine(HR=1.011,95%CI:1.008-1.014,P<0.001),and tubular atrophy/interstitial fibrosis(T1/T2)(HR=6.595,95%CI:3.107-13.999,P<0.001)were independent predictors of poor renal

关 键 词：肾小球肾炎 IGA 免疫球蛋白A 补体C3 预后 

分 类 号：R692.31[医药卫生—泌尿科学]