免疫球蛋白、轻链及比值在慢性肾脏疾病中的应用价值

The application value of immune globulin,free immune globulin light chain and kappa/lambda ratio in kidney disease

目的探讨免疫球蛋白IgG、IgA、IgM,补体C3、免疫球蛋白轻链κ/λ比值变化在慢性肾衰竭与肾病综合征患者诊断中的价值。方法在特种蛋白分析仪上通过免疫散射比浊法检测58例CRF患者、43例NS患者及50例健康体检者血清免疫球蛋白IgG、IgA、IgM,补体C3、免疫球蛋白轻链κ、λ含量并计算κ/λ值,同时利用全自动生化分析仪检测24 h TP-U含量。结果与正常组比较,CRF患者免疫球蛋白IgM、C3显著降低(P<0.05),κ/λ比值增高(P<0.05),但免疫球蛋白IgG、IgA差异无统计学意义(P>0.05),与正常组比较,NS患者免疫球蛋白IgG、C3降低(P<0.05),IgM、κ/λ比值增高(P<0.05),但IgA差异无统计学意义(P>0.05);比较NS组与CRF组,NS组IgM较CRF组显著增高(P<0.05),IgG较CRF组显著降低(P<0.05),C3较CRF组降低不明显,但IgA、κ/λ与CRF组比较差异无统计学意义(P>0.05)。结论慢性肾脏疾病患者免疫球蛋白、免疫球蛋白轻链、补体、尿蛋白及轻链比值都有一定的变化规律可寻,可以作为慢性肾脏损害疾病的无创伤指标,对临床诊疗、监测及预后具有重要意义。

Objective To explore the value of immune globulin, complement C3 and free immune globulin light chain kappa/ lambda ratio in diagnosis and treatment of chronic renal failure and nephrotic syndrome. Methods By means of immune turbidimetry, Au- tomated protein analysis BNII was used to detect immune globulin IgG, IgA and IgM, complement C3, free immune globulin light chain kappa and lambda and then calculate kappa/lambda ratio in 58 patients with chronic renal failure, 43 patients with nephrotic syndrome and 50 healthy people received physical examination. Automatic biochemistry analyzer was used for detecting 24hPRO. Results Compared with healthy people group, the immune globulin IgM and complement C3 levels of CRF patients were obviously lower （P 〈0.05） ;the kappa/lambda ratio level was higher （P 〈0.05） ,but the immune globulin IgG and IgA had no significant difference （P 〉0.05） ;The levels of immune globulin IgG and complement C3 were lower in NS patients group than those in healthy people group （P 〈 0.05）. While immune globulin IgM, kappa/lambda ratio were higher, but immune globulin IgA had no significant difference between them;Comparing NS pa- tients group and CRF patients group, the level of immune globulin IgM was totally higher than CRF patients group （P 〈 0. 05）, while im- mune globulin IgG was much lower （ P 〈 0. 05 ） and complement C3 decreased not obviously, but there was no significant difference in im- mune globulin IgG and kappa/lambda ratio. Conclusion The immune globulin, free immune globulin light chain, complement, urine protein and kappa/lambda ratio of chronic kidney disease have its own regulations, they have great significance in clinical diagnosis and treatment, prognosis and monitoring of chronic kidney disease as the noninvasive indexes.