补体C3与原发性膜性肾病患者尿蛋白水平及蛋白尿缓解情况的相关性  

Association of complement C3 with urine protein level and proteinuria remission status in patients with primary membranous nephropathy

作　　者：陈思 潘赢 陆益霏 钱力 李青 徐一力 段俗言 吴琳 张波 邢昌赢 毛慧娟 袁杨刚 Chen Si;Pan Ying;Lu Yifei;Qian Li;Li Qing;Xu Yili;Duan Suyan;Wu Lin;Zhang Bo;Xing Changying;Mao Huijuan;Yuan Yanggang(Department of Nephrology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]江苏省人民医院(南京医科大学第一附属医院)肾内科,南京210000

出　　处：《中华肾脏病杂志》2024年第9期705-715,共11页Chinese Journal of Nephrology

基　　金：国家自然科学基金(82170699,81870469,81670628)。

摘　　要：目的:探究补体C3与原发性膜性肾病患者尿蛋白水平及蛋白尿缓解情况的相关性,以期更好地指导临床个体化治疗。方法:该研究为单中心回顾性研究。收集2017年1月至2022年6月南京医科大学第一附属医院行肾活检的原发性膜性肾病患者的临床资料。对24 h尿蛋白量≥3.5 g且接受标准治疗患者出院后随访,以最后1次门诊或住院复查作为随访终点。收集24 h尿蛋白量,评估蛋白尿缓解情况。Kaplan-Meier法分析血清及肾组织补体与蛋白质缓解的相关性。Cox回归分析法分析血清C3水平及肾组织C3沉积情况与蛋白尿缓解的相关性。结果:该研究纳入507例原发性膜性肾病患者,年龄54(43,64)岁,男性312例(61.54%)。与24 h尿蛋白量<3.5 g组相比,24 h尿蛋白量≥3.5 g组男性比例(χ^(2)=22.479,P<0.001)、年龄(Z=-2.521,P=0.012)、收缩压(Z=-4.148,P<0.001)、舒张压(Z=-4.084,P<0.001)、血清磷脂酶A2受体抗体滴度(Z=-7.019,P<0.001)、总胆固醇(Z=-8.796,P<0.001)、三酰甘油(Z=-6.158,P<0.001)、低密度脂蛋白胆固醇(Z=-8.716,P<0.001)、血清肌酐(Z=-7.368,P<0.001)、血清C3(Z=-3.663,P<0.001)、血清C4(Z=-6.560,P<0.001)、使用糖皮质激素比例(χ^(2)=116.417,P<0.001)和使用免疫抑制剂比例(χ^(2)=53.839,P<0.001)均较高,而血清白蛋白(Z=12.518,P<0.001)、eGFR(Z=6.345,P<0.001)和血IgG(Z=7.321,P<0.001)均较低。在268例随访队列中,基线24 h尿蛋白量为7.15(5.14,10.24)g,血清磷脂酶A2受体抗体滴度为61.44(14.35,193.24)RU;ml,血清C3为1.005(0.864,1.150)g;L,血清C4为0.260(0.214,0.317)g;L。Kaplan-Meier生存曲线结果显示,血清C3>1.005 g;L组蛋白尿未完全缓解率低于血清C3≤1.005 g;L组(Log-rankχ^(2)=4.757,P=0.029),而血清C4≤0.260 g;L组和血清C4>0.260 g;L组蛋白尿未完全缓解率的差异无统计学意义(Log-rankχ^(2)=3.543,P=0.060)。肾组织C1q(Log-rankχ^(2)=0.167,P=0.683)、C4(Log-rankχ^(2)=1.927,P=0.165)沉积对膜性肾病患者蛋白尿缓解情况无明显�Objective To investigate the correlation between complement C3 and urine protein level and proteinuria remission status in patients with primary membranous nephropathy(PMN),and better guide individualized clinical treatment.Methods It was a single-center retrospective study.The clinical data of PMN patients who underwent renal biopsy in the First Affiliated Hospital of Nanjing Medical University from January 2017 to June 2022 were collected.Patients with 24 h urinary protein≥3.5 g were followed up after receiving standard treatment,and the last outpatient or inpatient review was used as the end point of follow-up.24 h urine protein was collected to evaluate the remission status of proteinuria.Kaplan-Meier method was used to analyze the correlation between serum and renal complements and proteinuria remission.Cox regression analysis method was used to analyze the correlation between serum C3 level and renal tissue C3 deposition and proteinuria remission.Results This study included 507 PMN patients with 312(61.54%)males,aged 54(43,64)years old.Compared with 24 h urinary protein<3.5 g group,proportion of males(χ^(2)=22.479,P<0.001),age(Z=-2.521,P=0.012),systolic blood pressure(Z=-4.148,P<0.001),diastolic blood pressure(Z=-4.084,P<0.001),serum anti-phospholipase A2 receptor(PLA2R)antibody titer(Z=-7.019,P<0.001),total cholesterol(Z=-8.796,P<0.001),triglyceride(Z=-6.158,P<0.001),low density lipoprotein cholesterol(Z=-8.716,P<0.001),serum creatinine(Z=-7.368,P<0.001),serum C3(Z=-3.663,P<0.001),serum C4(Z=-6.560,P<0.001),proportion of glucocorticoid use(χ^(2)=116.417,P<0.001)and proportion of immunosuppressant use(χ^(2)=53.839,P<0.001)were all higher,while serum albumin(Z=12.518,P<0.001),estimated glomerular filtration rate(Z=6.345,P<0.001)and serum IgG(Z=7.321,P<0.001)were all lower in 24 h urinary protein≥3.5 g group.There were 268 patients included in the follow-up cohort with baseline 24 h urinary protein of 7.15(5.14,10.24)g,serum anti-PLA2R antibody titer of 61.44(14.35,193.24)RU;ml,serum C3 of 1.005(0.864,

关 键 词：肾小球肾炎 膜性 补体C3 蛋白尿 

分 类 号：R692[医药卫生—泌尿科学]