IgA肾病补体C3、IgG、IgM肾脏沉积及其病理相关性的研究

Relationship between renal deposition of complement C3,IgG,IgM and pathology in IgA nephropathy

目的 探讨IgA肾病(IgA nephropathy,IgAN)患者补体C3、IgG、IgM肾脏沉积对肾脏病理损伤的影响。方法 回顾性分析2019年8月至2021年1月于昆明医科大学第一附属医院肾内科行肾活检确诊为原发性IgAN的患者119例,根据Lee分级将患者分为LeeⅠ+Ⅱ级组、LeeⅢ级组、LeeⅣ+Ⅴ级组,比较3组患者一般资料、实验室资料及病理资料的差异,采用Logistic回归分析IgAN患者病理Lee分级的独立危险因素,并应用Lee分级及牛津病理分型方法对肾小球免疫球蛋白及补体的沉积作评价,探讨其对肾脏病理的损伤作用。结果 (1)多因素Logistic回归分析发现血红蛋白、白蛋白下降,血肌酐、胱抑素C、视黄醇结合蛋白升高以及补体C3沉积是影响IgAN患者肾活检Lee分级的独立危险因素;(2)IgA、IgM、IgG以及补体C3病理沉积强度与它们的血清水平之间没有相关性(P>0.05);(3)牛津分型M1组、S1组补体C3(2+)~(3+)沉积率高于M0、S1组(P<0.05);(4)牛津分型E1组IgG沉积阳性率高于E0组(P<0.05)。结论 (1)IgAN患者肾组织补体C3高度沉积可能促进系膜细胞增生和肾小球节段性硬化或粘连;(2)IgAN患者肾组织IgG的病理沉积可能与肾小球毛细血管内细胞增生有关;(3)IgAN患者肾脏组织IgM的沉积可能是非特异性的。

Objective To explore the effects of complement C3,IgG and IgM renal deposition on renal pathological injury in patients with IgA nephropathy.Methods From August 1,2019 to January30,2021,retrospective review was performed for electronic medical records of 119 patients with primary IgA nephropathy diagnosed by renal biopsy.They were divided into three groups according to Lee grading scheme.The differences of general profiles,laboratory parameters and pathological findings among three groups were compared.The independent influencing factors of pathological Lee grades were examined by Logistic regression.Glomerular immunoglobulin and complement deposition were evaluated by Lee grading scheme and Oxford pathological classification and their effects on renal injury examined.Results Multivariate Logistic regression analysis revealed that reductions of hemoglobin and albumin,elevated levels of serum creatinine,Scr,cystatin C,retinol-binding protein and complement C3 deposition were independent factors affecting the Lee grades of renal biopsy in IgAN patients.No correlation existed between serum levels of IgA,C3,IgM,IgG and the intensity of pathological deposition(P>0.05).According to Oxford classification,the deposition rate of complement C32+~3+was higher in M1/S1 group than that in M0/S1 group(P<0.05).The positive rate of IgG deposition was higher in Oxford type E1 group than that in E0 group(P<0.05).Conclusion High deposition of complement C3in renal tissue promotes mesangial cell proliferation and glomerular segmental sclerosis or adhesion.The deposition of IgG in renal tissue IgAN may be correlated with cellular proliferation in glomerular capillaries.The deposition of IgM may be non-specific in renal tissue of IgAN patients.