伴或不伴C3沉积原发性膜性肾病的临床病理特点及预后分析

Clinicopathological features and prognosis of primary membranous nephropathy with or without C3 deposition

目的探讨原发性膜性肾病(primary membranous nephropathy,PMN)患者伴或不伴肾小球补体(complement,C3)沉积的临床病理特点及预后。方法回顾性分析2016年1月至2021年12月在宁波市泌尿肾病医院行肾穿刺确诊的PMN患者280例,根据C3沉积强度将患者分为不伴沉积组(n=129)及伴C3沉积组(n=151),采用Kaplan-Meier法和Cox回归分析法比较两组患者的临床、病理及预后。结果伴C3沉积组的24h尿蛋白量、肾病综合征比例、抗PLA2R抗体阳性比例、节段性硬化比例、免疫球蛋白(immunoglobulin,Ig)G、IgM、IgA、C1q及纤维蛋白原沉积比例均高于不伴C3沉积组(P<0.05),而血白蛋白和临床缓解率低于不伴C3沉积组(P<0.05)。C3沉积对PMN患者肾脏复合终点事件无明显影响(P=0.806),但C3沉积是临床缓解的影响因素(P=0.030)。Kaplan-Meier法显示两组累积肾脏存活率比较,差异无统计学意义(P=0.805),但伴C3沉积组患者的临床缓解率低于不伴C3沉积组(P=0.009)。结论伴C3沉积的PMN患者临床及病理表现更加严重,不伴C3沉积的PMN患者临床缓解率更高,但伴C3沉积的PMN患者与不伴C3沉积的PMN患者的预后无差异。

Objective To explore the clinicopathological features and prognosis of primary membranous nephropathy(PMN)with or without C3 deposition.Methods Retrospective analysis of 280 cases of PMN diagnosed by renal puncture in Ningbo Urology&Neghnology Hospital from January 2016 to December 2021 were retrospectively collected.According to the strength of C3 glomerular deposition,the patients were divided into the C3 deposition group(n=151)and the without C3 deposition group(n=129).Finally,clinical,pathological and prognosis,the prognosis of two groups were compared by Kaplan-Meier and Cox regression analysis.Results 24h UTP,nephrotic syndrome proportion,positive serum anti-PLA2R antibodies proportion,segmental sclerosis proportion,immunofluorescence IgG,IgM,IgA,C1q and fibrinogen deposition proportion in the C3 deposition were higher than the without C3 deposition group(P<0.05).Albumin level and clinical remission rate in the C3 deposition was lower than the without C3 deposition group(P<0.05).C3 deposition had no effect on the kidney composite end-point events(P=0.806),but C3 deposition was a factor of total remission of primary membranous nephropathy patients(P=0.030).Kaplan-Meier analysis showed that there was no significant difference in cumulative kidney survival rate between the two groups(P=0.805),but the clinical remission rate in the C3 deposition group was lower than the without C3 deposition group(P=0.009).Conclusion The clinical and pathological manifestations of PMN patients with C3 deposition are more serious,and the clinical remission rate of PMN patients without C3 deposition is higher,but the prognosis of PMN patients without C3 deposition has no difference to that of PMN patients with C3 deposition.