低补体C3血症及肾组织补体C3沉积在乙肝相关性肾病中的意义

Significance of decreased serum C3 level and C3 deposition in the kidney of patients with HBV related glomerulonephritis

目的探讨补体活化在乙肝相关性肾病中的意义。方法分析乙肝相关性肾病患者29例。低补体C3血症的定义为血清补体C3<85 mg/d L,根据血清补体C3水平分为正常补体C3组和低补体C3组,比较2组在病理及临床指标之间的差异。根据免疫荧光下补体C3在肾组织中沉积情况,分为阴性、阳性两组,比较两组在病理及临床指标之间的差异。结果29例患者中,正常补体C3组患者18例(62.07%),低补体C3组患者11例(37.93%),与正常补体C3组相比,低补体C3组患者的血肌酐较高,eGFR水平较低(P<0.05);低补体C3组的系膜增生、肾间质纤维化病理指标平均积分显著高于正常补体C3组(P<0.05)。肾组织补体C3沉积阴性组共9例(31.03%),阳性组共20例(68.97%),随肾组织补体C3沉积增多,患者血清胆固醇及Ig G水平升高,血白蛋白、血清补体C3和eGFR降低(P<0.05);肾组织补体C3沉积阳性组肾小球硬化、肾间质炎性细胞浸润、肾小管萎缩、肾间质纤维化程度显著高于阴性组(P<0.05)。结论乙肝相关性肾病患者常伴随不同程度的补体系统活化,肾脏局部与全身补体活化明显的患者肾脏损伤更为严重,提示补体活化参与乙肝相关性肾病的发生发展。

Objective To investigate the clinical significance of complement activation in patients with HBV related glomerulonephritis（HBV-GN）.Methods Biopsy-proven HBV-GN patients admitted in our hospital were retrospectively recruited.Decreased serum C3 level was defined as C3 85 mg/d L.According to the serum C3 level,the patients were divided into the decreased serum C3 group and normal serum C3 group,and the pathological and clinical differences were compared between the two groups.According to the intensity of C3 deposition in the kidney,patients were divided into negative and positive group,and the pathological and clinical differences were compared.Results In this study,29 HBV-GN patients were recruited.There were 18（62.07%） patients in the normal serum C3 group and 11（37.93%） patients in the decreased serum C3 group.Compared with the patients with normal serum C3 level,patients with decreased serum C3 level had higher serum creatinine level,lower eGFR level,severer mesangial proliferation and renal interstitial fibrosis（P〈0.05）.There were 9（31.03%） patients with negative C3 deposition in the kidney,and 20（68.97%） patients with positive C3 deposition.Higher cholesterol,higher Ig G levels,lower serum albumin,serum C 3 levels,lower eGFR level,severer glomerular sclerosis,inflammatory cell infiltration in renal interstitial,renal tubular atrophy,and renal interstitial fibrosis were associated with a higher grade of C3 deposition in the kidney（P〈0.05）.Conclusion There are different levels of complement activation in patients with HBV-GN.Local and systemic complement activation is associated with decreased renal function.Complement activation may be involved in the development of HBV-GN.