血清IgA/C3在IgA肾病辅助诊断及病情监测中的应用

Progress of research on pathogenesis and diagnosis indexs of IgA nephropathy

目的探讨血清免疫球蛋白A、补体C3和IgA/C3比值在IgA肾病诊断中的价值,及与IgA肾病病情监测之间的联系,为IgA肾病的诊断和分级提供微创、简易的新思路。方法收集来自大连某医院的60例IgA肾病患者、60例非IgA肾病患者、40例健康体检者的血清及24 h尿液标本,分别检测三组的多项生化和免疫学临床指标,进行综合分析。结果三组人群的血清肌酐、尿素、尿酸、白蛋白、胆固醇、三酰甘油、血红蛋白、24 h尿蛋白、IgA、以及IgA/C3水平上均有统计学差异IgA和IgA/C3比值,在观察组、肾病对照组和正常对照组之间应用统计学两两比较,结果均存在显著差异(P<0.01)。观察组与肾病对照组之间的C3水平并不存在显著差异(P>0.05)。通过诊断疾病的特异性和敏感度研究中分析,IgA和IgA/C3在区分IgA肾病和非IgA肾病时均存在一定的特异性和敏感度,且IgA/C3明显优于IgA。而C3在区分这两种疾病时不具有参考价值。Lee氏病理分级反映了IgA肾病病情的轻重程度,结果显示,IgA和IgA/C3在Ⅲ-Ⅴ级组明显高于对照组(P<0.01),而C3在Lee分级Ⅰ-Ⅱ级组和Ⅲ-Ⅴ级组间无明显差异(P>0.05)。结论 IgA/C3与IgA肾病的关系紧密,在IgA肾病诊断和病情监测中具有较高的参考意义和探索价值。

Objective To explore the value of serum IgA,serum C3 and IgA/C3 ratio in the diagnosis andclinical monitoring of IgA nephropathy,which provide new insight for the alternatives of renal biopsy. Methods In the first affiliated hospital of Dalian Medical University,60 patients with IgAN,60 patients with non-IgAN and40 healthy people were detected by blood biochemical indexes and immune indexes,such as the Urea,serum IgAand serum C3,IgA/C3 ratio. According to the healthy condition and Lee grading,we divided all the 160 patientsinto different groups. By comparing the blood biochemical indexes and immune indexes among these differentgroups,we investigated the relationship between the serum IgA/C3 ratio and the IgAN. Results Firstly,the levelof serum IgA and IgA/C3 were obviously different among the patients with IgAN,patients with non-IgAN andhealthy people（P〈0.01）. Secondly,the serum IgA and IgA/C3 have high specificity and sensitivity when distin-guishing between IgAN and non IgAN. Thirdly,the level of serum IgA and IgA/C3 have significant deference be-tween the patients with Lee Ⅰ-Ⅱ grading and the patients with Lee Ⅲ-Ⅴ grading,while the level of C3 is verysimilar between different groups in all the three situations mentioned above. Conclusion Our research providesstronge evidence demonstrates that the level of serum IgA/C3 ratio have close relationship with IgAN and they canserve as the reference index when diagnosising and grading IgAN.