免疫沉积C3与IgA肾病临床病理特征的关系

目的分析肾小球系膜区补体C3沉积在IgA肾病发病及进展中的意义，为疾病诊断、病情监测及判断预后提供依据。方法回顾性分析IgA肾病病人的临床及病理学检查指标，按照系膜区C3沉积强度进行分组，（-）为阴性组，（±~+）为弱阳性组，（2+~3+）为强阳性组，并对相应指标行统计学分析。结果按照补体C3沉积强度分类，3组分别为10例（23.3%）、13例（30.2%）和20例（46.5%），随组织C3沉积加重，血肌酐、尿素氮升高，eGFR降低，差异有统计学意义（P < 0.05~P < 0.01）。而在尿酸、24h尿蛋白定量及镜下血尿、血脂、血压、血糖差异均无统计学意义（P>0.05）。Pearson相关分析，补体C3强度与血清C3数值变化相反，但两者无显著相关性（P>0.05）。肾组织C3免疫荧光沉积强度与病理损害相关，在病理分级（Lee分级）方面，差异无统计学意义（P>0.05）；与系膜细胞增殖及毛细血管内皮细胞增生、球性硬化及肾小管间质病变（包括间质炎性细胞浸润、间质纤维化、肾小管萎缩）差异均有统计学意义（P < 0.05）。结论IgA肾病病人肾小球系膜区C3沉积的程度与血肌酐、尿素氮、eGFR及病理损害相关，可作为IgA肾病病情监测及判断预后的指标。

Relationship between the immuno-deposition of C3 and clinicopathological features of IgA nephropathy

ObjectiveTo analyze the significance of complement C3 deposition in the mesangial region of glomeruli in IgA nephropathy pathogenesis and progression, so as to provide the basis for disease diagnosis, condition monitoring and prognosis judgment.MethodsThe clinical and pathological examination indexes in patients with IgA nephropathy were retrospectively analyzed.According to the intensity of C3 deposition in the mesangial area, the patients were divided into the negative group[(-)], weak positive group[(±to +)] and strong positive group[(2+ to 3+)], and the corresponding indicators were statistically analyzed.ResultsAccording to the classification of complement C3 deposition intensity, 10 cases(23.3%) in the negative group, 13 cases(30.2%) in weak positive group and 20 cases(46.5%) in strong positive group were identified.With the aggravation of tissue C3 deposition, the blood creatinine and urea nitrogen increased, the eGFR decreased, and the difference of which was statistically significant(P < 0.05 to P < 0.01).However, the differences of the uric acid, 24 h urine protein quantification and microscopic haematuria, blood lipid, blood pressure and blood glucose were not statistically significant(P>0.05).The results of Pearson correlation analysis showed that the intensity of complement C3 was opposite to the value of serum C3, but there was no statistical significance between them(P>0.05).The intensity of C3 immunofluorescence deposition in renal tissue was correlated with the pathological damage, but the difference of pathological grading(Lee grading) was not statistically significant(P>0.05), and the differences of intensity of C3 immunofluorescence deposition in renal tissue among the different mesangial cell proliferation, capillary endothelial cell proliferation, globular sclerosis, and renal tubular interstitial lesions(including interstitial inflammatory cell infiltration, interstitial fibrosis and renal tubular atrophy) were statistically significant(P < 0.05).ConclusionsThe intensity of C3 deposition in the mesangial region of glomeruli in patients with IgA nephropathy is related to the serum creatinine, urea nitrogen, eGFR and pathological damage, and which may be used as an indicator to monitor and predict the prognosis of IgA nephropathy.