肾小球C1q与IgM沉积在成人特发性膜性肾病中的临床意义

Clinical significance of C1q and IgM glomerular deposition in adult idiopathic membranous nephropathy

目的:探讨肾小球C1q与IgM沉积在成人特发性膜性肾病(idiopathic membranous nephropathy,IMN)中的临床意义。方法:回顾性分析2016年4月至2018年9月在青岛大学附属烟台毓璜顶医院肾内科行肾活检并经北京大学第一医院电镜确诊的IMN患者,应用直接免疫荧光法检测肾小球C1q与IgM沉积强度,根据C1q及IgM沉积与否进行分组,对纳入患者的临床资料进行比较分析。结果:C1q,IgM沉积与否在发病年龄,性别,24 h尿蛋白定量,肌酐,尿酸,总胆固醇,三酰甘油,脂蛋白(a),血清IgG,IgA,C3,C4等方面差异无统计学意义(P>0.05)。C1q阳性组血白蛋白水平低于阴性组(P=0.04),但临床缓解率、IgM沉积率高于阴性组(P=0.027,P=0.011)。肾组织IgM阳性组血清IgM水平显著高于IgM阴性组(P=0.015)。C1q及IgM共同沉积组较阴性,但临床缓解率高(P=0.027)。结论:C1q沉积的IMN患者发病时血白蛋白水平较低,但临床缓解率较高,提示治疗效果较好,对临床预后判断有指导作用。

Objective: To explore the clinical significance of C1q and IgM glomerular deposition in adult idiopathic membranous nephropathy (IMN). Methods: Patients with biopsy-proven IMN from April 2016 to September 2018 in Department of Nephropathy of Affiliated Yantai Yuhuangding Hospital of Qingdao University were enrolled retrospectively. And renal specimens were evaluated with electron microscopy in the First Hospital of Peking University. C1q and IgM on the glomeruli were detected by direct immunofluorescence. Clinical data were compared between patients with and without C1q/IgM deposition. Results: There were no significant differences in age, sex, 24-urine protein, creatinine, uric acid, total cholesterol, triglyceride, lipoprotein(a), serum IgG, IgA, C3, C4 between patients with and without C1q deposition as well as with and without IgM deposition. Patients with C1q deposition had lower level of serum albumin (P=0.04), had higher level remission rate and had higher level of IgM deposition (P=0.027, P=0.011, respectively). Patients with IgM deposition presented with higher serum IgM (P=0.015). Conclusion: Patients with IMN and C1q deposition showed the lower level of serum albumin. However, they had the higher remission rate, which indicate that the C1q-positive might seem to respond more quickly to the immunosuppressive therapy compared with the C1q-negative. And it may serve as the guidance of clinical prognosis.