狼疮性肾炎患者肾组织中抗-C1q抗体与疾病活动性的关系研究

Relationship between Anti-C1q Antibody in Kidney Tissue of Lupus Nephritis Patients and Disease Activity

背景随着医学领域技术更新加快,国内外专家对抗-C1q抗体(抗-C1qAb)与狼疮性肾炎(LN)疾病活动性进行了较多研究,但由于新疆地区医疗技术薄弱,研究人才严重缺乏等原因,对此课题尚未开展系统的、完整的研究。目的探讨LN患者肾组织中抗-C1qAb与疾病活动性的关系。方法选取2006年7月—2013年7月于新疆医科大学第一附属医院肾病科住院行肾脏穿刺活检术的LN患者129例,根据患者肾组织中有无抗-C1qAb,分为抗-C1qAb阳性组(n=64)和抗-C1qAb阴性组(n=65),其中抗-C1qAb阳性患者根据肾组织中抗-C1qAb表达程度的不同可分为轻度组、中度组和重度组。记录患者临床表现,并抽取血液,检测红细胞沉降率(ESR)、球蛋白、血红蛋白(Hb)、血肌酐(Scr)、尿素氮(BUN)、清蛋白(Alb)、补体C_3、C_4水平。评估患者估算肾小球滤过率(eGFR),对系统性红斑狼疮(SLE)病情活动情况(SLEDAI)、LN活动性指数(AI)进行评分。结果两组患者性别、年龄、病程、收缩压(SBP)、舒张压(DBP)、ESR、球蛋白、Scr、BUN水平比较,差异均无统计学意义(P>0.05);抗-C1qAb阳性组Hb、Alb、C_3、C_4水平、eGFR低于抗-C1qAb阴性组,SLEDAI评分高于抗-C1qAb阴性组(P<0.05)。两组患者发热、颧部红斑、黏膜溃疡、关节痛/关节炎、心包炎、胸膜炎、管型尿、白细胞计数减少、血小板减少症发生率比较,差异均无统计学意义(P>0.05);抗-C1qAb阳性组蛋白尿、Hb减少、低C_3、低C_4发生率高于抗-C1qAb阴性组(P<0.05)。不同表达程度抗-C1qAb血清C_3、C_4水平、eGFR、SLEDAI、AI评分比较,差异均有统计学意义(P<0.001);其中抗-C1qAb轻度、中度、重度组血清C_3、C_4水平低于抗-C1qAb阴性组,AI评分高于抗-C1qAb阴性组;抗-C1qAb中度、重度组eGFR低于抗-C1qAb阴性组,SLEDAI评分高于抗-C1qAb阴性组;抗-C1qAb重度组血清C_3水平低于抗-C1qAb轻度组;抗-C1qAb中度组eGFR低于抗-C1qAb轻度组;抗-C1qAb中度、重度组AI评分高于抗-C1qAb轻度组(P<0.05)。结论抗-C1qAb在LN患者肾脏损害的发生、发展中起重要的作用,与肾脏病变程度及疾病活动性有密切相关性。

Background With the accelerated development of medical technology,the experts at home and abroad have conducted a lot of research on the anti-C1 q antibody（ anti-C1qAb） and lupus nephritis（ LN） disease activity.Unfortunately,the medical technology is weak in Xinjiang region,and the lack of research personnel is serious,this issue has not been carried out systematically and completely. Objective To study the correlation between anti-C1qAb in kidney tissue of LN patients and disease activity. Methods 129 cases of LN patients who underwent renal biopsy in Department of Nephrology of the First Affiliated Hospital of Xinjiang Medical University from July 2006 to July 2013, were selected as study subjects.According to whether anti-C1qAb in the kidney tissue existed,cases were divided into anti-C1qAb positive group（ n = 64） and anti-C1qAb negative group（ n = 65）. According to expression level of anti-C1qAb in the kidney tissue,anti-C1qAb positive patients were divided into mild group,moderate group and severe group. The clinical manifestations of patients were recorded,the blood was extracted, erythrocyte sedimentation rate（ ESR）, levels of globulin, hemoglobin（ Hb）, serum creatinine（ Scr）,blood urea nitrogen（ BUN）,albumin（ Alb）,complement C3 and C4were measured. Estimated glomerular filtration rate（ e GFR）,the SLE disease activity（ SLEDAI）,and LN activity index（ AI） were calculated. Results There were no significant difference in gender, age, course of the disease, SBP, DBP, ESR, levels of serum globulin, Scr and BUN between two groups of patients（ P〈0. 05）. Levels of Hb, Alb, C3,C4,and e GFR in anti-C1qAb positive group were significantly lower than those in anti-C1qAb negative group,and the SLEDAI score of anti-C1qAb positive group was significantly higher than that of anti-C1qAb negative group（ P〈0. 05）. There were no significant difference in incidences of fever,malar rash,ulcers, arthritis pain / joint inflammation, pericarditis, pleurisy, tube type urine, aleucocytosis and thrombocytopenia between two groups of patients（ P〈0. 05）; the incidences of protein urine, decreased Hb, low levels of C3 and C4in anti-C1qAb positive group were significantly higher than those in anti-C1qAb negative group（ P〈0. 05）. There were significant differences in serum levels of C3 and C4,e GFR,SLEDAI and AI score among groups with different anti-C1qAb degree（ P〈0. 001）. Serum C3 and C4level in mild group, moderate group and severe group were significantly lower than those in anti-C1qAb negative group respectively,AI score in mild group,moderate group and severe group was significantly higher than that in anti-C1qAb negative group respectively; e GFR in moderate group and severe group was significantly lower than that in anti-C1qAb negative group respectively and SLEDAI score in moderate group and severe group was significantly higher than that in anti-C1qAb negative group respectively; serum C3 level in severe group was significantly lower than that in mild group; e GFR in moderate group was significantly lower than that in mild group; AI score in moderate group and severe group was significantly higher than that in mild group respectively（ P〈0. 05）. Conclusion Anti-C1qAb in LN patients plays an important role in the development of renal damage,and it correlates closely with the degree of kidney disease and disease activity.