肾组织C3免疫荧光在评估狼疮肾炎中的意义与临床分析

Direct immunofluorescence determination of the complement 3 in renal tissues to assess lupus nephritis: Clinical significance and clinical analysis

目的:探讨狼疮肾炎(LN)患者肾组织C3免疫荧光沉积强度与临床实验室指标、SLE疾病活动度、肾脏病理活动性的关系。方法:收集并分析49例LN患者(均行肾活检)的临床表现、实验室指标和病理资料。结果:49例LN患者以单纯Ⅲ型和Ⅳ型为主,共占60%,Ⅲ型或Ⅳ型混合Ⅴ型者占28%,单纯Ⅴ型占8%。强免疫荧光组血清学C3、C4更低,抗dsDNA抗体滴度更高,SLEDAI积分较高(P<0.05)。Ⅲ型和Ⅲ+Ⅴ型组合并,Ⅳ型和Ⅳ+Ⅴ型组合并,两合并组免疫荧光强弱差异有统计学意义(χ~2=5.559,P=0.018)。强免疫荧光组肾脏病理活动指数(AI)高于弱免疫荧光组(P<0.05)。结论:推断肾组织C3荧光沉积强度可能作为预测LN病情活动及严重程度的参考指标,从而帮助判断预后指导治疗。

Objective:To investigate the relationship between the intensity of complement 3(C3)deposition C3 by immunofluorescence and the clinical laboratory indicators,activity of systemic lupus erythematosus(SLE)and renal pathological activity in lupus nephritis(LN).Methods:The data were obtained in 49 patients with LN concerning the clinical picture,laboratory and pathological findings.Results:Of the 49 cases,typeⅣ(33%)and typeⅢ(27%)were the most common.Simple typeⅢor concomitant typeⅣwithⅤwere 28%,and simple typeⅤwas 8%.Cases in the strong immunofluorescence had higher serum C3 and C4 levels as well as higher levels of anti-dsDNA antibody,systemic lupus erythematosus disease activity index(SLEDAI)and active index(AI)(all P<0.05).The difference was significant between simple typeⅢand TypeⅢ+Ⅴ,and typeⅣand typeⅣ+Ⅴin cases with weak immunofluorescence intensity(χ2=5.559,P=0.018).Cases with strong immunofluorescence had higher renal pathological activity than those with weak immunofluorescence(P<0.05).Conclusion:Evaluation of C3 in renal tissues by immunfluorescence deposition may be used as an indicator for predicting the activity and severity of LN.