血清补体C1q及IgG水平对急性肾小球肾炎预后的预测价值研究

Prognostic value of serum C1q and IgG levels in patients with acute glomerulonephritis

目的观察急性肾小球肾炎(acute glomerulonephritis,AGN)患者血清补体C1q(complement C1q,C1q)、IgG水平变化,探讨血清C1q、IgG评估AGN预后的价值。方法AGN患者150例,均给予规范药物治疗并随访根据1年,117例预后良好者为预后良好组,33例预后不良者为预后不良组。比较两组一般资料及入院时血清C1q、IgG水平;多因素logistic回归分析影响AGN患者预后的因素;绘制ROC曲线,评估血清C1q、IgG诊断AGN患者预后不良的效能。结果预后不良组年龄[(40.12±3.48)岁]大于预后良好组[(25.36±1.14)岁](t=39.266,P<0.001),肉眼血尿持续时间[(3.21±0.58)周]长于预后良好组[(2.55±0.42)周](t=7.290,P<0.001),血清C1q[(0.31±0.04)g/L]、IgG[(6.48±1.03)g/L]水平低于预后良好组[(0.42±0.05)、(9.69±1.02)g/L](t=13.174,P<0.001;t=15.933,P<0.001);2组体质量指数、高血压持续时间及男性、抽烟、饮酒、先驱感染、肉眼血尿、高血压、心电图异常、合并乙型肝炎、合并肾盂肾炎比率比较差异无统计学意义(P>0.05)。年龄(OR=1.258,95%CI:0.771~1.745,P<0.001)、血尿持续时间(OR=2.477,95%CI:2.477,P=0.003)、血清C1q(OR=3.165,95%CI:1.975~4.355,P<0.001)、血清IgG(OR=3.428,95%CI:2.145~4.711,P<0.001)是影响AGN患者预后的因素。血清C1q、IgG分别以0.38、7.45 g/L为最佳截断值,单独及联合预测AGN患者预后不良的AUC分别是0.774(95%CI:0.711~0.837,P<0.001)、0.728(95%CI:0.684~0.772,P<0.001)、0.795(95%CI:0.725~0.865,P<0.001),灵敏度分别为78.76%、72.73、75.76%,特异度分别为73.50%、70.94%、78.63%。结论AGN患者年龄大、血尿持续时间延长及血清C1q、IgG水平降低与预后不良有关,血清C1q、IgG在AGN预后评估中有一定价值。

Objective To investigate the predictive value of serum complement C1 q(C1 q)and immunoglobulin G(IgG)levels for the prognosis of acute glomerulonephritis(AGN).Methods All 150 AGN patients were treated with drugs.According to the prognosis one year after treatment,they were divided into a good prognosis group of 117 cases and a poor prognosis group of 33 cases.ELISA method was used to detect the serum C1 q and IgG levels of patients upon admission;The general data of two groups were compared,logistic regression analysis of related factors affecting the prognosis of AGN patients;ROC curve was drawn to evaluate the value of serum C1 q and IgG levels in diagnosing the prognosis of AGN patients.Results The age of the poor prognosis group was(40.12±3.48)years older than the good prognosis group(25.36±1.14)years old,the duration of gross hematuria was(3.21±0.58)weeks longer than the good prognosis group(2.55±0.42),serum C1 q(0.31±0.04)g/L and IgG(6.48±1.03)g/L levels were lower than the good prognosis group(0.42±0.05)g/L and(9.69±1.02)g/L(P<0.05),other parameters(gender,BMI,smoking,drinking,Precursor infection,gross hematuria,hypertension,duration of hypertension,abnormal ECG)and good prognosis group were not statistically different(P>0.05).Multivariate logistic regression analysis showed that age(OR=1.258,95%CI:0.771~1.745,P<0.001),duration of hematuria(OR=2.477,95%CI:2.477,P=0.003),serum C1 q(OR=3.165,95%CI:1.975-4.355,P<0.001)and IgG(OR=3.428,95%CI:2.145-4.711,P<0.001)were the prognostic factors of AGN.ROC curve analysis showed that serum C1 q and IgG(the best cut-off values of serum C1 q and IgG were 0.38 g/L and 7.45 g/L),and the AUC alone and in combination to predict poor prognosis of AGN patients were 0.774(95%CI:0.711~0.837,P<0.001),0.728(95%CI value:0.684~0.772,P<0.001),0.795(95%CI value:0.725~0.865,P<0.001),the sensitivity is 78.76%,72.73 and 75.76,respectively%,the specificity is 73.50%,70.94%and 78.63%respectively.Conclusion The prognosis of AGN is affected by many factors,the decrease of serum C1 q and IgG levels is related to poor prognosis among them,and can be used for patient prognosis assessment.