补体C3系膜区沉积强度与IgA肾病病理分型的相关性  

The relationship between msangial C3 deposition and pathological classification of IgA nephropathy

作　　者：陈盼盼 周蓓 何娟 李嵘 马峰 CHEN Panpan;ZHOU Bei;HE Juan;LI Rong;MA Feng(Department of Nephrology, The First Affiliated of Hospital of PLA Air Force Medical University, Xi'an 710032, China)

机构地区：[1]空军军医大学第一附属医院肾脏内科,陕西西安710032

出　　处：《西部医学》2021年第12期1783-1786,1792,共5页Medical Journal of West China

基　　金：国家自然科学基金(81700676)。

摘　　要：目的探讨补体C3系膜区强度与IgA肾病(IgAN)病理分型的相关性。方法回顾性收集空军军医大学西京医院2016年1月1日~2019年12月31日行肾活检穿刺诊断为IgAN患者1094例,参照纳入及排除标准,最终入选975例。依据免疫荧光下补体C3在系膜区沉积强度,分为C3阴性组(n=213)和C3阳性组(n=762)。分析肾活检诊断为IgAN患者补体C3系膜区沉积强度与IgA肾病Lee氏分级和牛津分型的相关性,并评估补体C3系膜区沉积强度与临床病理的相关性。结果C3阴性组较C3阳性组血肌酐水平低,eGFR高和血补体C3水平高,差异有统计学意义(P<0.05)。C3阴性患者在Lee氏I级的比例最高(50.5%),之后逐渐递减,Lee氏IV-V级的比例最低(9.8%),而在Lee氏V级的比例升高(20.5%),呈现为“杓型”曲线。C3阴性组患者病理组织改变M1、E1、S1、T1-2和C1-2的比例显著少于C3阳性组,差异有统计学意义(P<0.05)。结论补体C3阴性的发生率与IgA肾病Lee氏分级呈现为“杓型”曲线;补体C3阴性IgAN患者病理改变较轻或病变慢性化,活动性病变少见。Objective To explore the relationship between msangial C3 deposition and pathological classification of IgA nephropathy.Methods We reviewed renal biopsy–proven patients between January 1,2016 and December 31,2019 in the Xijing Hospital.Patients were divided into the two groups,negative group(-or±)and positive group(≥1+),according to the intensity of C3 deposition in mesangial area of glomurili.Results The remaining 975 patients were included in the study.The incidence of C3 negative patients was 21.8%.Compared to the C3 positive group,there were lower serum creatinine,higher eGFR and serum C3 in the C3 negative group.The proportion of C3 negative patients was the highest in grade I(50.5%)of Lee’s grading system for IgAN,then gradually decreased,was the lowest in gradeⅣ-Ⅴ(9.8%),and was increased in grade V(20.5%),which presented an“arytenoid”curve.Compared to the C3 positive group,there were less patients with M1、E1、S1、T1-2and C1-2 in the C3 negative group.Conclusions The relationship between the incidence of C3 negative patients and Lee’s grading system for IgAN present an“arytenoid”curve.The pathological lesion is mild or chronic in C3 negative patients.

关 键 词：肾小球肾炎 IGA 补体C3 Lee氏分级 

分 类 号：R692.6[医药卫生—泌尿科学]