血浆甘露聚糖结合凝集素与类风湿关节炎肾损害的相关性研究

The study on the correlation between serum mannose-binding lectin and renal injury in rheumatoid arthritis

目的检测类风湿关节炎（RA）相关性肾损害患者甘露聚糖结合凝集素（MBL）的血浆水平，探讨MBL在RA相关肾损害中可能的作用机制。方法用酶联免疫吸附试验（ELISA）法检测19例RA相关肾损害患者、49例RA不伴肾损害患者及40名健康对照者的血浆MBL水平，并收集RA患者临床资料及相关实验室检查资料进行对比分析。采用r检验、t检验和Spearman相关分析进行统计学处理。结果较无肾损害组比，RA相关肾损害组患者肿胀压痛关节数增多[（15＋9）和（9±11）个]，晨僵时间延长[（2．9±1．3）和（2_3±1．6）h]，其他（除肾脏）关节外伴随症状发生率明显升高[（42．1％和16．3％），P〈0．0l或P〈0．05]；但二组间RA病程、关节畸形的发生率差异无统计学意义（P〉0．05）；RA相关肾损害组血小板（PLT）[（376±155）x109／L和（304±121）x109／L]、循环免疫复合物（CIC）[（4．3±3．0）和（2．9±3．3）g／L]、红细胞沉降率（ESR）[（79±46）和（53±31）mm／1h]、类风湿因子（RF）[（77±42）和（52±49）U／m1]、C反应蛋白（CRP）[（32±28）和（23±18）mg／L]、免疫球蛋白IgG[（11．7±2．6）和（8．4±2．4）g，L]、补体c3[（1．18±0．53）和（0．94±0．21）g／L]高于RA无肾损害组（P〈0．01或P〈0．05），血浆白蛋白（Alb）[（26±13）比（30±9）g／L]低于无肾损害组（P〈O．05）；二组RA患者血浆MBL水平均较对照组血浆MBL水平[（3．1±0．5）mg／L]显著下降（P〈o．01），RA相关肾损害组MBL水平[（1．7±1．2）mg／L!较无肾损害组MBL水平[（1．4±1．3）mg／L]升高（P〈0．05）；RA相关肾损害组MBL与IgG、C3、CRP、尿蛋白定量（24h）呈正相关（r分别为0．6，0．6，0．47，0．57；P〈0．05）。结论RA相关肾损害与免疫复合物相关；RA相关肾损害患者血浆MBL水平是升高的，血浆中高水平MBL可能是RA相关肾损害的发病机制之一。

[Abstract] Objective To detect the serum level of mannose binding lectin （MBL） in patients with renal injury induced by rheumatoid arthritis （RA）, and to investigate the role of MBL in the pathogenesis of renal injury in RA. Methods ELISA was used to measure the serum MBL level of 19 RA patients with renal injury, 49 RA patients without renal injury and 40 healthy individuals. The clinical features and laboratory markers were compared and analyzed by chi-square test, two independent samples t-test and Spearman＇s correlation analysis. Results Compared with RA patients without renal injury, the number of tender and swollen joints [（15±9） vs （9±11）], duration of morning stiffness [（2.9±1.3） vs （2.3±1.6） hi and extra- articular manifestations （42.1% vs 16.3% ） in RA patients with renal injm7 were significantly higher （P〈0.05 or P〈0.01 ）. There was no significant difference between the two groups in RA disease duration and joint deformity （P〉O.05）. In patients with renal injury, the level of platelet count [ （ 376± 155 ） ×10^9/L vs （ 304± 121 ） ×10^9/L], CIC[（4.3±3.0）vs （2.9±3.3）g/L], ESR[（79±46）vs （53±31）mm/1 h], RF[（77±42）vs （52±49） U/ml], CRP[（32±28）vs （23-±18）mg/L], IGG[（11.7±2.6）vs （8.4±2.4）g/L], C3[（1.18-±0.53）vs （0.94± 0.21 ） g/L] were higher than those in RA patients without renal injury （P〈O,01 or P〈0.05）; the level of Alb [（26±13） vs （30-±9） g/L] was lower than that in RA patients without renal injury （P〈0.05）. The level of serum MBL in the two groups of RA patients was significantly lower than that in the healthy group [ （3.1±0.5） mg/L]（P〈0.01）, and the level of serum MBL in RA patients with renal injury [（1.7-±1.2） mg/L] was higher than that in RA patients without renal injury [（1.4±1.3） mg/L] （P〈0.05）. The level of serum MBL in RA patients with renal injury showed a positive correlation with IgG, C3, CRP and 24 h urine protein level （r= 0.6, 0.6, 0.47, 0,57; P〈0.05）. Conclusion Renal injury in RA patients is immune complex dependent. The serum level of MBL is higher in patients with renal injury, therefore, high-concent,ation MBL may be one of a potential causes of renal injury in RA patients.