血清补体C1q和胱抑素C在IgA血管炎的临床意义

Clinical significance of serum complement C1q and cystatin C in IgA vasculitis

目的探讨IgA血管炎(immunoglobulin A vasculitis,IgAV)患儿血清补体C1q、C3、C4及胱抑素C(cystatin C,Cys-C)水平变化及其临床意义。方法选取IgAV患儿180例,根据患儿是否累及肾脏分为肾损害组(n=73)和非肾损害组(n=107)。监测患儿血清补体C1q、C3、C4及Cys-C水平,进行两组间比较;绘制ROC曲线,分析补体C1q、C3、C4及Cys-C水平对肾损害的临床应用价值。结果肾损害组补体C1q、C3、C4及Cys-C水平均高于非肾损害组(P<0.05);以肾损害组补体C1q、Cys-C及二者联合检测水平绘制ROC曲线,其曲线下面积(AUC)分别为0.961,0.630和0.962,最佳截断值分别是188.5 mg/L,0.705 mg/L,0.551,敏感性分别为82.2%,68.5%和87.7%,特异度分别为100%,52.3%和91.0%。结论补体C1q、Cys-C水平可能与IgAV病情严重程度有一定的关系,有望成为目前临床评价早期肾损伤的指标。

Objective To explore the serum levels of complement C1q,C3,C4 and Cys-C and their clinical significance in children with immunoglobulin A vasculitis.Methods A total of 180 IgAV children were selected and divided into kidney damage group(n=73)and non-renal damage group(n=107).The serum levels of complement C1q,C3,C4 and Cys-C were monitored and compared between the two groups.The ROC curve was drawn to analyze the clinical application value of complement C1q,C3,C4 and Cys-C levels in renal injury.Results The levels of complement C1q,C3,C4 and Cys-C in kidney damage group were higher than those in non-renal damage group(P<0.05).The area under the ROC curve(AUC)was 0.961,0.962 and 0.630 for complement C1q,Cys-C and their combined detection in kidney damage group,respectively,and the optimal cut-off value was 188.5 mg/L,0.705 mg/L and 0.551,respectively.The sensitivity was 82.2%,68.5%and 87.7%,respectively,and the specificity was 100%,52.3%and 91.0%,respectively.Conclusion The levels of complement C1q and Cys-C may have a certain relationship with the severity of IgAV disease,and are expected to be a clinical indicator for early renal injury evaluation.