儿童原发性肾病综合征患者血清补体C1q水平变化及其临床意义

Study on Serum Levels of C1q and Their Clinical Significance in Children with Nephrotic Syndrome

目的分析原发性肾病综合征(PNS)患儿血清补体C1q水平的变化,探讨急性期和恢复期NS患儿血清补体C1q水平的差异及其与其他生化指标的相关性。方法收集2016年3月~10月在南京大学医学院附属金陵医院肾内科住院并确诊的儿童PNS患者标本141例,其中急性期NS患儿78例、恢复期NS患儿63例。分别检测NS患儿和健康对照儿童(77例)的血清补体C1q水平,同时测定其血清总蛋白(TP)、清蛋白(ALB)、血脂[包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]及肾功能指标[尿素(Urea)、肌酐(Cr)、尿酸(Uric)]水平,并进行统计学分析。结果急性期NS组血清补体C1q水平为203.50(183.75~223.75)mg/L(F=30.92,P<0.001),恢复期NS组血清补体C1q水平为185.0.0(161.00~202.00)mg/L(F=30.92,P=0.020<0.05),均明显高于正常对照组173.00(161.00~185.00)mg/L;且急性期NS患儿血清补体C1q水平明显高于恢复期患儿(F=30.92,P<0.001)。Spearman相关性分析显示,NS患儿血清补体C1q水平与TC(r=0.483,P<0.001),TG(r=0.423,P<0.001)和LDL-C(r=0.450,P<0.001)水平均呈正相关,与TP(r=-0.276,P=0.001<0.01),ALB(r=-0.410,P<0.001)呈负相关。逐步多元回归分析显示,在校正其他相关因素的影响下,PNS患儿血清补体Clq水平与TG水平呈高度相关(β=9.235,P<0.001,校正R^2=0.215)。结论 PNS患儿血清补体C1q水平明显升高,且与病情和血脂水平相关,有望作为其临床病情评估的新指标。

Objective To analyze serum levels of Clq in children with nephrotic syndrome （NS）,and investigate the clinical significance and the relationship among the altered serum Clq levels and other lipid/lipoprotein and renal＇ function parame- tersin children with NS inacute and remission phases. Methods Serum levels of Clq were measured in 78 NS children with acute phase,in 64NS children with remission and in 77 healthy control children. The other lipid/lipoprotein and renal func- tion parameters were also analyzed in these children, including TP, ALB, TC, TG, LDL-C, HDL-C, Urea, Cr and Uric. Results Compared with the healthy control children 1-173.00（161.00-185.00）mg/L] ,children with NS inacute [203.50（183.75 -223.75）mg/L] and remission phases [185.00（161.00-202.00）mg/L] all had a significantly increasedserum levels of Clq. Compared with NS children in remission,those in acute phase showed a significantly increased Clq （P〈0. 001）. In all the NS children,the serum levels of Clq were positively correlated with the levels of TC （r=0. 483,P〈0. 001）,TG （r= 0. 423,P〈0. 001） and LDL-C （r=0. 450,P〈0. 001） ,while negatively correlated with the levels of TP （r= -0. 276,P= 0. 001〈0.01） and ALB （r=-0. 410 ,P〈0. 001）. Multiple linear regression analyses showed that serum levels of Clq were independently associated with serum TG levels （β=9. 235 ,P〈0. 001 ;adjusted R^2 =0. 215） after adjustment of other related factors. Conclusion Serum levels of Clq were significantly increased in NS children in association with their conditions and the levels of lipid/lipoprotein parameters,and may be function as anovel parameter for assessing the development of NS.