不同牛津病理分型IgA肾病患者炎症指标、IgA及IgA/C3水平的变化及其临床意义

Changes of inflammatory indexes,IgA,and IgA/C3 levels in patients with IgA nephropathy of different Oxford pathological types and their clinical significance

目的检测不同牛津病理分型IgA肾病患者的炎症指标、IgA及IgA/补体3(C3)水平,并探讨其临床意义。方法选择2016年6月至2019年5月于湛江中心人民医院肾内科就诊的60例IgA肾病患者(IgA肾病组)为研究对象,参考牛津病理分型将所有患者分为轻度组36例和重度组24例。另选择非IgA肾病原发性肾小球肾炎患者40例作为对照组。检测所有患者的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)、IgA及IgA/C3水平,分析IgA、IgA/C3对不同牛津病理分型的诊断灵敏度和特异度。结果IgA肾病组患者的IgA、IgA/C3水平分别为(2.95±0.78)g/L、3.07±1.02,明显高于对照组的(2.24±0.62)g/L、2.35±0.74,差异均有统计学意义(P<0.05),而两组患者的C3水平比较差异无统计学意义(P>0.05);轻度组患者的IgA、IgA/C3水平分别为(2.68±0.63)g/L、2.69±0.75,明显低于重度组的(3.09±0.77)g/L、3.31±1.02,差异均有统计学意义(P<0.05)。而两组患者的C3水平比较差异无统计学意义(P>0.05);轻度组和重度组患者IL-6[(106.28±25.25)ng/L vs(142.18±29.61)ng/L]、TNF-α[(119.76±28.37)ng/L vs(47.42±32.15)ng/L]、TGF-β1[(19.84±5.59)μg/L vs(33.47±7.86)μg/L]水平比较,轻度组明显低于重度组,差异均有统计学意义(P<0.05);IgA和IgA/C3区分IgA肾病患者轻度与重度病理改变的灵敏度分别为53.07%、64.05%,特异度分别为75.12%、68.09%,提示鉴别轻度和重度IgA肾病的准确性较差。结论IgA肾病患者的牛津病理分型各个病理指标表现越明显,炎症指标、IgA及IgA/C3水平越高,但IgA及IgA/C3对鉴别IgA肾病轻度和重病理改变的灵敏度和特异度较差,仅可作辅助指标应用。

Objective To detect the inflammatory indexes,IgA,and serum immunoglobulin A/complement factor 3(IgA/C3)levels in patients with IgA nephropathy of different Oxford pathological types and to explore their clinical significance.Methods A total of 60 IgA nephropathy patients(IgA nephropathy group),who were treated in the Department of Nephrology,Zhanjiang Central People’s Hospital from June 2016 to May 2019,were selected as the study objects.All patients were divided into the mild group(n=36)and severe group(n=24)according to Oxford pathological classification.In addition,40 patients with non-IgA nephropathy primary glomerulonephritis were selected as the control group.The levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),transforming growth factor-β1(TGF-β1),IgA and IgA/C3 were measured in all patients,and the diagnostic sensitivity and specificity of IgA and IgA/C3 to different Oxford pathological types were analyzed.Results The levels of IgA and IgA/C3 in IgA nephropathy group were(2.95±0.78)g/L and 3.07±1.02,which were significantly higher than corresponding(2.24±0.62)g/L and 2.35±0.74 in the control group(P<0.05),but there was no significant difference in C3 level between the two groups(P>0.05);IgA and IgA/C3 levels in the mild group were(2.68±0.63)g/L,2.69±0.75,respectively,which were significantly lower than corresponding(3.09±0.77)g/L and 3.31±1.02 in the severe group(P<0.05);there was no significant difference between the two groups in C3 level(P>0.05);the levels of IL-6,TNF-α,TGF-β1 in the mild group were(106.28±25.25)ng/L,(119.76±28.37)ng/L,(19.84±5.59)μg/L,respectively,which were significantly lower than corresponding(142.18±29.61)ng/L,(47.42±32.15)ng/L,(33.47±7.86)μg/L in severe group(all P<0.05);the sensitivity of IgA and IgA/C3 were 53.07%and 64.05%and the specificity were 75.12%and 68.09%,indicating that the accuracy was poor in distinguishing mild from severe IgA nephropathy.Conclusion The more obvious the Oxford pathological classification of IgA nephropathy is,the higher the level of inflammation index,IgA and IgA/C3 is.However,the sensitivity and specificity of IgA and IgA/C3 to distinguish mild and severe pathological changes of IgA nephropathy are poor,which can only be used as auxiliary indexes.