血清补体C1q、C3与中性粒细胞胞浆抗体相关性血管炎患者临床特征、病理类型及预后相关性研究

Correlation between serum complement C1q,C3 and clinical features,pathological types and prognosis of patients with ANCN-associated vasculitis

目的:分析抗中性粒细胞胞浆抗体(ANCA)相关性血管炎患者临床症状、病理类型、血清补体C1q、C3及临床预后等状况,探究血清补体C1q、C3在ANCN相关性血管炎患者中的临床价值。方法:选取88例ANCA相关性血管炎(AAV)患者作为观察组研究对象,同期选取进行体检的88例健康患者作为对照组研究对象。根据血清补体C1q水平将AAV患者分为低C1q组与正常C1q组;根据血清补体C3水平将AAV患者分为低C3组与正常C3组。①比较观察组与对照组患者血清补体C1q、C3水平;②对不同C1q水平组别患者基本资料及实验室指标进行比较;③分析血清补体C1q水平与患者临床特征、病理类型及预后的关系;④对不同C3水平组别患者基本资料及实验室指标进行比较;⑤分析血清补体C3水平与患者临床特征、病理类型及预后的关系。结果:①与对照组相比,观察组的AAV患者体内血清补体C1q、C3水平明显降低(均P>0.05)。②低C1q组和正常C1q组患者性别、年龄、ANCA分型以及C3水平比较均无统计学差异(均P>0.05),低C1q组β2-微球蛋白(β-2MG)水平显著高于正常C1q组,免疫球蛋白M(IgM)、红细胞计数(RBC)、血红蛋白(Hb)以及乳酸脱氢酶(LDH)水平显著低于正常C1q组(均P<0.05)。③低C1q组和正常C1q组患者各项临床特征的发生率以及病理类型比较均无统计学差异(均P>0.05),低C1q组终末期肾脏病(ESRD)的发生率明显高于正常C1q组(P<0.05)。④低C3组和正常C3组患者性别、年龄、ANCA分型以及C1q水平比较均无统计学差异(均P>0.05),低C3组β-2MG、血尿素氮(BUN)、胱抑素C(CysC)、腱生蛋白(Tn)、脑钠肽(BNP)以及LDH水平显著高于正常C3组,PLT、WBC、以及Hb水平显著低于正常C3组(均P<0.05)。⑤低C3组和正常C3组患者各项临床特征的发生率以及病理类型比较均无统计学差异(均P>0.05),低C3组ESRD的发生率明显高于正常C3组(P<0.05)。结论:AAV患者体内血清补体C1q、C3水平明显低于健康人群,低C1q、C3水平的AAV患者临床预后明显更差,同时发现低C3水平AAV患者肾功能受损严重,在临床实践中要密切注意患者血清补体C1q、C3水平,早期对患者采取积极有效的措施进行干预,改善预后,具有很高的临床诊疗价值。

Objective:To analyze the clinical symptoms,pathological types,serum complement C1q,C3 and clinical outcomes of patients with neutrophil cytoplasmic antibody(ANCA)-associated vasculitis,and to explore the clinical value of serum complement C1q and C3 in ANCN-associated vasculitis.Methods:A total of 88 patients with ANCA-associated vasculitis(AAV)were selected as the observation group,and 88 healthy patients who underwent physical examination during the same period were selected as the control group.AAV patients were divided into low C1q group and normal C1q group according to serum complement C1q level,and divided into low C3 group and normal C3 group according to serum complement C3 level.The serum complement C1q and C3 levels in the observation group and the control group were recorded and compared.The basic data and laboratory indexes of patients in different C1q level groups were compared,and the relationship between serum complement C1q level and clinical characteristics,pathological types and prognosis of patients was analyzed.The basic data and laboratory indexes of patients in different C3 level groups were compared,and the relationship between serum complement C3 level and clinical characteristics,pathological types and prognosis of patients was analyzed.Results:Compared with the control group,the serum levels of complement C1q and C3 in the observation group were significantly decreased(all P<0.05).There was no significant difference in sex,age,ANCA classification and C3 levels between the low-C1q and normal-C1q groups(all P>0.05).The level ofβ-2MG in lower-C1q group was higher than that in normal-C1q group,while the levels of IgM,RBC,Hb and LDH were lower than those in normal-C1q group(all P<0.05).No significant difference was found between the low-and normal-C1q groups in the incidence of all clinical characteristics and pathological types(all P>0.05),and the low-C1q group had a significantly higher incidence of ESRD than the normal-C1q group(all P<0.05).There was no significant difference in sex,age,ANCA classification and C1q level between the low-and normal-C3 groups(all P>0.05),while the levels ofβ-2MG,BUN,CysC,Tn,BNP and LDH in low-C3 group were higher than those in normal-C3 group,and the levels of PLT,WBC and Hb were lower than those in normal-C3 group(all P<0.05).There was no significant difference in the incidence of clinical characteristics and pathological types between the low-C3 group and the normal-C3 group(all P>0.05),while the incidence of ESRD in the low-C3 group was significantly higher than that in the normal-C3 group(all P<0.05).Conclusion:The serum levels of complement C1q and C3 in AAV patients are significantly lower than those in healthy people,and the clinical prognosis of AAV patients with low C1q and C3 levels is significantly worse.In clinical practice,it is necessary to pay close attention to the serum complement C1q and C3 levels of patients,and to take active and effective measures to intervene in patients in the early stage to improve the prognosis,which has a high clinical diagnosis and treatment value.