血清IgA/C3比值在IgA肾病患者临床诊断与预后中的价值

目的探讨血清IgA/C3比值在IgA肾病诊断和预后评价中的意义。方法选择原发性IgA肾病患者176例,根据血清IgA/C3比值分组,比较组间包括收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）、血肌酐（Cr）、尿素氮、24 h尿蛋白定量、甘油三酯和胆固醇等临床资料的差异。病理积分采用Katafuchi评分标准,比较血清IgA/C3比值与IgA肾病病理损伤指标的关系。结果①IgA肾病组较对照组血清IgA、IgA/C3比值水平明显增高。②与IgA/C3〈4.5组相比较,IgA/C3〉4.5组患者SBP、DBP、MBP、Cr和IgA明显升高,C3明显降低。③与IgA/C3〈4.5组比较,IgA/C3〉4.5组患者肾小球硬化、肾间质炎细胞浸润、间质纤维化、肾小管萎缩平均积分明显升高。④血清IgA/C3比值与临床指标相关分析显示,血清IgA/C3比值与年龄、SBP、Cr和胆固醇呈正相关。⑤血清IgA/C3比值与病理指标相关分析显示,IgA/C3比值与肾小球硬化、肾间质炎细胞浸润、肾间质纤维化、肾小管萎缩呈正相关。结论血清IgA/C3比值可能成为鉴别IgA肾病与非IgA肾病的临床参考指标,同时,血清IgA/C3比值能够反映IgA肾病肾脏病理损害的严重程度,是预测IgA肾病预后的无创性临床指标之一。

Diagnosis and prognosis value of determination of serum IgA /C3 ratio in patients with IgA nephropathy

Objective To analyze the correlation between serum IgA/C3 ratio with clinical and histological damages in IgA nephropathy. Methods 176 patients with IgA were divided according to IgA / C3 ratio. The severity of histological lesions was classified by using Katafuchi scale,and 30 patients with non- IgA were for controls. IgA,C3,blood lipid,DBP,SBP,MBP and CR were measured and compared. Results The serum IgA level and IgA / C3 ratio were significantly higher,while its C3 level was lower in patients with severe IgA compared to those with non- IgA. SBP,DBP,MBP and CR in the group with high serum IgA / C3（ 4. 5 and above） were significantly higher. The ratio（ %） of patients with severe IgA in whom hematuria disappeared,was significantly higher in the low,than in the high serum IgA / C3 group. Conclusion The serum IgA / C3 ratio can reflect the histological severity of IgA and could serve as a marker of the progression of IgA.