IgA肾病患者肾组织、血清、尿液C_(4d)水平与病情和疗效的关系  

Relationships of C_(4d)levels in renal tissues,serum and urine with condition and curative effect of patients with IgA nephropathy

作　　者：王真硕 李艳存 李巧英 WANG Zhenshuo;LI Yancun;LI Qiaoying(Department of Clinical Laboratory,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院检验科,北京100035 [2]北京市大兴区中西医结合医院肾内科 [3]北京市大兴区中西医结合医院急诊内科

出　　处：《山东医药》2023年第14期21-24,共4页Shandong Medical Journal

基　　金：国家卫生计生委医药卫生科技发展研究中心课题(W2019ZT652)。

摘　　要：目的探讨肾组织、血清、尿液中人补体片段4d(C_(4d))水平对IgA肾病(IgAN)患者病情、疗效及预后的评估价值。方法选取原发性IgAN患者214例,采用经皮肾穿刺活检术取肾组织,免疫组化法检测C_(4d)表达情况;采集患者血清和尿液,ELISA法检测C_(4d)水平。比较肾组织、血清及尿液C_(4d)不同表达水平患者的临床病理资料。给予ACEI/ARB药物联合免疫抑制剂治疗6~8个月后观察疗效,采用Spearman相关分析法分析肾组织、血清、尿液C_(4d)表达与治疗效果的相关性。于随访截止日对患者进行肾功能CDK分期,比较不同分期患者肾组织、血清、尿液C_(4d)表达水平差异。结果肾组织C_(4d)表达阳性76例、阴性138例,血清C_(4d)水平为(1270.27±332.99)ng/mL,尿液C_(4d)水平为(297.53±45.53)ng/mL。与肾组织C_(4d)阴性患者比较,肾组织C_(4d)阳性患者24 h尿蛋白定量更高,血白蛋白更低(P均<0.05);与血清C_(4d)低水平患者比较,血清C_(4d)高水平患者24 h尿蛋白定量更高,血白蛋白更低(P均<0.05);与尿液C_(4d)低水平患者比较,尿液C_(4d)高水平患者MAP、24 h尿蛋白定量、Scr更高,eGFR、血白蛋白更低(P均<0.05),且病理分期更为严重。治疗后214例患者完全缓解143例,部分缓解28例,无反应(无效+终末期肾病)43例。相关性分析显示,肾组织、血清、尿液C_(4d)水平升高与IgAN患者的治疗效果呈负相关(rs分别为-0.234、-0.270、-0.324,P均<0.01),其中尿液C_(4d)与治疗效果的相关性最强。截至随访日,患者肾功能CDK分期1期57例、2期43例、3期31例、4期34例、5期23例。相关性分析显示,肾组织、血清、尿液C_(4d)水平升高与IgAN患者肾脏病分期均呈正相关(rs分别为0.252、0.202、0.431,P<0.05或<0.01),其中尿液C_(4d)与肾脏病分期的相关性最强。结论IgAN患者肾组织、血清、尿液C_(4d)表达水平与病情、疗效及预后均有一定的关系,且以尿液C_(4d)关系最为密切。Objective To explore the value of the levels of human complement fragment 4d(C_(4d))in renal tissues,serum and urine in evaluating the condition,curative effect and prognosis of patients with IgA nephropathy(IgAN).Meth⁃ods Totally 214 patients with primary IgAN were selected.The renal tissue was taken by percutaneous renal biopsy,and the expression of C_(4d)was observed by immunohistochemistry.We collected the patients'serum and urine,and detected the level of C_(4d)by ELISA.The clinical data of patients with different levels of C_(4d)expression in the renal tissues,serum and urine were compared.After 6 to 8 months of treatment with ACEI/ARB combined with immunosuppressive agents,the therapeutic effect was observed.The correlation between the expression of C_(4d)in the renal tissues,serum and urine and the therapeutic effect of IgAN patients was analyzed by Spearman correlation analysis.CDK staging of renal function was per⁃formed on the deadline of follow-up to compare the difference in the expression of C_(4d)in the renal tissues,serum and urine of patients in different stages of renal disease.Results The expression of C_(4d)in the renal tissues was positive in 76 cases and negative in 138 cases.The expression level of serum C_(4d)was(1270.27±332.99)ng/mL,and the expression level of urine C_(4d)was(297.53±45.53)ng/mL.Compared with renal C_(4d)-negative patients,the renal C_(4d)-positive patients had higher 24-hour urinary protein and lower serum albumin(both P<0.05).Compared with patients with low expression of se⁃rum C_(4d),patients with high expression of serum C_(4d)had higher 24-hour urinary protein and lower serum albumin(both P<0.05).Compared with patients with low expression of urine C_(4d),patients with high expression of urine C_(4d)had higher MAP,24-hour urine protein content,and Scr,and lower eGFR and serum albumin(all P<0.05),and had more severe glomerular pathological changes.After treatment,there were 143 cases of complete remission,28 cases of partial remis⁃sion,and 43 cases of no respo

关 键 词：人补体片段4d 肾组织 血清 尿液 IGA肾病 

分 类 号：R692.6[医药卫生—泌尿科学]