内科理论与实践2017，Vol.12Issue(6)：380-385,6.DOI:10.16138/j.1673-6087.2017.06.004
低C3血症及补体旁路途径异常活化与IgA肾病临床病理特征及预后分析
The correlation of decreased serum C3 and abnormal activation of alternative complement pathway with clinicopathological manifestations and prognosis of IgA nephropathy
章晓炎 1徐静 2潘晓霞 2谢静远 2欧阳彦 2俞夏莲 2璩斌3
作者信息
- 1. 上海交通大学医学院附属瑞金医院老年科,上海200025
- 2. 上海交通大学医学院附属瑞金医院肾脏科,上海200025
- 3. 上海交通大学医学院附属瑞金医院检验科,上海200025
- 折叠
摘要
Abstract
Objective To investigate the correlation of decreased serum C3 and abnormal activation of the alternative complement pathway with clinicopathological severity and prognosis of IgA nephropathy(IgAN).Methods The clinical,pathological and follow-up data of primary IgAN patients at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from January 2010 to December 2014 were analyzed retrospectively.Levels of serum C3 were detected by immunoscattering turbidimetry.Patients with C3＜0.85 g/L and C3 ≥0.85 g/L were categorized into the hypo-C3 group and the normal C3 group,respectively.Clinical,pathological manifestations and prognosis between the two groups were compared.Enzyme-linked immunosorbent assay(ELISA) was used to detect the serum factors involved in alternative complement pathway,including human terminal complement complex (SC5b-9),C3a,complement factor H (CFH),complement factor B(CFB) and complement factor I(CFI).Results Altogether 363 IgAN patients were recruited,133 (36.6％) were categorized into the hypo-C3 group.Compared with normal C3 group,patients in hypo-C3 group had higher proportion of microscopic hematuria,lower hemoglobin level and lower estimated glomerular filtration rate(eGFR),and higher proportion of segmental glomerulosclerosis.Cox regression model showed that decreased serum C3 was an independent risk factor for end-stage renal disease in IgAN.Compared with normal C3 group,patients in hypo-C3 group had significantly higher levels of C3a and SC5b-9,and lower levels of C4,CFH,CFI and CFB.Compared with patients with normal serum SC5b-9,patients with elevated serum SC5b-9 had lower serum albumin.Compared with patients with normal serum CFH,patients with decreased serum CFH were younger.There were no significant differences in other clinical indicators and prognosis between normal and abnormal serum SC5b-9 groups,as well as between normal and abnormal serum CFH groups.Conclusions IgAN patients with decreased serum C3 had severe clinical and pathological manifestations and poor prognosis.Abnormal activation of alternative complement pathway was involved in some patients with decreased serum C3,suggesting the association between abnormal activation of alternative complement pathway and pathogenesis and progression of IgAN.关键词
IgA肾病/低C3血症/补体旁路途径过度活化Key words
IgA nephropathy/Decreased serum C3/Abnormal activation of alternative complement pathway分类
医药卫生引用本文复制引用
章晓炎,徐静,潘晓霞,谢静远,欧阳彦,俞夏莲,璩斌..低C3血症及补体旁路途径异常活化与IgA肾病临床病理特征及预后分析[J].内科理论与实践,2017,12(6):380-385,6.
