血清补体C1q在成人肾病综合征中的表达及意义  

The Expression and Significance of C1q in Adult Nephrotic Syndrome

作　　者：于庆飞[1,2] 武爽[3] 陈兵[1] 王荣[1] 张磊[2] 刘超[2] 

机构地区：[1]山东大学附属省立医院肾内科,济南山东250021 [2]山东省交通医院肾内科,济南山东250031 [3]张店区人民医院皮肤科,淄博山东255000

出　　处：《药物生物技术》2015年第6期496-501,共6页Pharmaceutical Biotechnology

基　　金：山东省自然科学青年基金(No.ZR2013HQ033)

摘　　要：探讨成人肾病综合征(Nephrotic syndrome,NS)患者血清和肾脏病理组织中的C1q表达及与其他生化指标的相关性,并动态观察其与疾病进展的相关性,以期了解C1q在NS中的临床意义。收集正常人101例和NS患者266例血清进行C1q的检测,NS患者均行肾穿刺活检及免疫荧光、光镜和电镜检查。对70例膜性肾病进行了跟踪随访,其中膜性肾病患者根据组织中C1q有无阳性分为C1q+组(34例)与C1q-组(36例),两组均应用激素加环磷酰胺治疗6个月后,观察两组的缓解率有无不同。结果:与健康组(174.5±24.4)mg/L和继发性NS组(170.1±35.4)mg/L相比,原发性NS组血清C1q(193.1±30.8)mg/L明显增高(P<0.01);其中,微小病变性患者中血清C1q(215.2±36.2)mg/L明显高于其他组(P<0.01)。在肾脏病理组织中,膜性肾病中C1q阳性率(46.3%)明显高于其他病理类型(P<0.01),其中,C1q2+以上表达的占19.8%;另外,在原发性NS中诊断C1q肾病1例。膜性肾病患者随访结果示:C1q-组显示完全缓解率(50%)明显高于C1q+组(17.6%)(P<0.05),总缓解率差异无显著性。两组中完全缓解患者血清C1q水平(169.2±18.6)mg/L明显低于部分缓解(197.5±38.2)和不缓解患者(194.2±24.1)mg/L;而在继发性NS组,狼疮性肾炎血清C1q(151.4±30.3)mg/L明显低于其他继发疾病,肾组织中C1q阳性率为100%。在所有NS患者中,血清补体C1q与病理组织中的C1q呈负相关(r=-0.344,P<0.01)。血清补体C1q与血清Ig M(r=0.422,P<0.01)、C3(r=0.667,P<0.01)、C4(r=0.480,P<0.01)呈正相关。升高的血清C1q参与了原发性NS的发病,尤其是微小病变患者,而在继发性NS中降低的C1q与狼疮性肾炎的发生发展密切相关。To analyze the level of C1 q and to investigate the correlations among serum C1 q,C1q of renal tissues,other biochemical indexes and progression of disease in order to understand the clinical significance of C1 q in NS. The levels of serum C1 q were detected in 101 cases of healthy people and 266 cases of patients with NS. Renal biopsy was performed in patients with NS,and immunofluorescence was used to detect the deposition of Ig G,Ig A,Ig M,C3,C1 q,and Fib in the renal tissues and,at the same time light and electron microscopy examination was also included. The basic information and clinical characteristics of NS patients were collected,and immunoglobulin,complement and other related indicators were completed for each patient at the same time. At the same time,70 patients with membranous nephropathy were followed up. The patients were divided into C1 q +( 34 cases) and C1q-( 36 cases)according to deposition of C1 q in kidney tissues,both groups were treated with corticosteroid plus cyclophosphamide for 6 months,then the remission rates of the two groups were observed. Compared with( 174. 5 ± 24. 4) mg / L in normal healthy people and( 170. 1 ± 35. 4) mg/L in secondary NS patients,the level of serum C1 q was increased significantly( 193. 1 ± 30. 8) mg/L in primary NS patients( P < 0. 01). Serum C1 q level( 215. 2 ± 36. 2) mg / L of patients in MCD group was significantly higher than that as the other groups in primary NS patients( P < 0. 01),C1 q + deposition rate( 46. 3%) in membranous nephropathy was significantly higher than that as other pathological types in renal pathological tissue( P < 0. 01),and the rate of C1q2 + in membranous nephropathy was19. 8%. In addition,1 case of C1 q nephropathy was diagnosed in primary NS. Follow-up results of 70 patients with membranous nephropathy showed that the complete response rate( 50%) in C1q-group was significantly higher than that( 17. 6%) in C1 q + group( P <0. 05),and there was no significant difference in total remission rate. In addtion,the serum C1 q level(

关 键 词：血清补体C1q 肾病综合征 补体 狼疮性肾炎 

分 类 号：R692[医药卫生—泌尿科学]