糖尿病肾病病理特征与补体C3沉积的关系及其对患者临床症状的影响

Relationship between pathological features of diabetic nephropathy and complement C3 deposition and its influence on clinical manifestation

目的 研究糖尿病肾病病理特征与肾组织补体C3沉积的关系及其对患者临床症状的影响.方法 选择太原市中心医院2006年4月至2016年4月收治的经肾穿刺活检确诊为糖尿病肾病患者115例,对其临床资料进行回顾性分析.根据补体C3沉积情况,将入选患者分成C3阳性组（39例）和C3阴性组（76例）,比较两组各项临床指标及肾脏病理指数;同时对比不同病理分型（Ⅰ～Ⅳ组）间C3沉积的差别及患者预后情况.结果 C3阳性组和C3阴性组患者年龄、糖尿病病情等比较差异未见统计学意义（P〉0.05）;C3阳性组的24 h尿蛋白定量和血清肌酐水平高于C3阴性组,肾小球滤过率低于C3阴性组（P〈0.05）;病理分型Ⅰ～Ⅳ组患者的补体C3沉积阳性率比较差异有统计学意义（P〈0.05）,随着病理等级的升高,C3沉积阳性率也随之增加;C3阳性组的活动指数（7.0±1.5）高于C3阴性组（4.3±1.3）,C3阳性组的慢性指数（4.5±1.7）低于C3阴性组（6.5±1.6）,P〈0.05;所有患者随访2年发现,患者病理等级越高,预后越差.结论 肾组织C3沉积在一定程度上会对糖尿病肾病患者的临床表现及病理产生不良影响,并影响患者预后.

Objective To study the relationship between pathological characteristics of diabetic nephropathy and complement C 3 deposition of renal tissue and its influence on clinical symptoms of patients.Methods A total of 115 patients with renal biopsy-proven diabetic nephropathy in Taiyuan Central Hospital from April 2006 to April 2016 were selected and their clinical data were retrospectively analyzed .According to the deposition of complement C 3 , all the patients were divided into C 3 positive group （39 cases） and C3 negative group （76 cases） to compare clinical indexes and renal pathological index of the two groups.Meanwhile, the differences of C3 deposition and prognosis of patients with different pathological types （Ⅰ-Ⅳ group） were compared.Results There was no significant difference in age, condition of diabetes mellitus between C3 positive group and C3 negative group （P〉0.05）;the 24 h urinary protein and serum creatinine levels in C 3 positive group were higher than those in C 3 negative group , and the glomerular filtration rate in C3 positive group was lower than that in C 3 negative group （ P〈0.05 ）; the difference in the positive rate of complement C 3 deposition among patients in pathological classifications Ⅰ to Ⅳ group was statistically significant （P〈0.05）;the positive rate of C3 deposition increased with the increase in pathological grade; the activity index of C 3 positive group （7.0 ±1.5） was significantly higher than that of C 3 negative group （4.3 ±1.3）, and the chronic index of C3 positive group （4.5 ±1.7） was lower than that of C3 negative group （6.5 ±1.6）, P〈0.05.All patients were followed up for 2 years.The prognosis of patients got worse with the increase of pathological grade .Conclusions The deposition of complement C 3 in kidney tissue may have adverse effects on the clinical manifestation and pathology of patients with diabetic nephropathy , and affect the prognosis .