C1q在成人肾病综合征中的表达及意义

发布时间：2018-02-22 12:30

本文关键词： 补体C1q 肾病综合征狼疮性肾炎膜性肾病微小病变　出处：《山东大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的1.通过检测成人肾病综合征(Nephrotic syndrome,NS)患者血清中补体Clq的表达和肾脏病理组织中的Clq的沉积,探讨患者血清和肾脏病理组织中的Clq表达与肾小球疾病病理类型、病因的相关性；2.动态观察血清中的Clq水平与组织中的Clq表达与膜性肾病进展的相关性,以期了解血清Clq及病理组织中的Clq在膜性肾病中的疗效评价及预后的临床意义。方法1.临床资料266例肾病综合征(NS)患者为实验组,所有实验组患者均符合肾病综合征的诊断标准,并为首次发病的患者。同时收集患者的信息,包括性别,年龄,发病时间,首发症状,发病病程,每位患者均行肾活检,并同时行下列检查：包括尿常规、血常规、肝功、肾功、血糖、血脂、24小时尿蛋白定量、β2微球蛋白、免疫球蛋白加补体、dsDNA、ANA、SM、病毒学指标、ANCA、GBM、血轻链、免疫固定电泳、肿瘤标志物的检测；另外,收集健康成人101例作为对照组。2.收集所有实验组患者及对照组人群的血清,低温冷冻,之后统一进行C1q的检测；血清Clq检测：将人血清标本保存于2-8℃；将样本分别加入两个试剂盒,分别孵育5分钟,读出数据,计算出结果。3.肾病综合征患者均行经皮肾脏穿刺活检,穿刺的肾组织均进行免疫荧光、光镜和电镜检查。4.在195例原发性肾病综合征中,在膜性肾病中根据肾组织中Clq表达的不同,选取34例Clq表达阳性的患者组与36例Clq表达阴性的患者组,一共70例,两组均应用激素加环磷酰胺治疗6个月,对其进行跟踪随访；观察两组的缓解率有无不同,以期了解血清C1q及病理组织中的Clq在膜性肾病中的疗效评价及预后的临床意义。结果1.与101例健康对照组(174.5±24.4)mg/L和71例继发性NS病例组(170.1±35.4)mg/L相比,195例原发性NS病例组血清C1q(193.1±30.8)mg/L明显增高(P0.01)；其中,微小病变性患者中血清C1q(215.2±36.2)m∥L明显高于其他组(P0.01)。2.在肾脏病理组织中,膜性肾病中C1q阳性率(46.3%)明显高于其他病理类型(P0.01)；其中,肾组织免疫荧光中C1q≥-++表达的占19.8%；原发性肾病综合征中确诊1例C1q肾病。3.对70例原发肾病综合征中病理类型为膜性肾病的患者随访结果示：36例肾组织中Clq表达阴性的患者治疗后完全缓解率(50%)明显高于34例肾组织中C1q表达阳性的患者(17.6%)(P0.05),总缓解率也略增高,但无显著差异性(P=0.13)。两组病例中完全缓解患者血清Clq水平(169.2+18.6)mg/L明显低于部分缓解(197.5±38.2)和不缓解患者(194.2±24.1)mg/L。4.在71例继发性NS组中,狼疮性肾炎血清C1q(151.4±30.3)mg/L明显低于其他继发疾病中的血清Clq,而肾组织中Clq阳性表达率为100%。5.无论在继发性还是原发性NS患者中,血清中的补体C1q与病理组织中的C1q呈负相关(ｒ=-0.344,P0.01)。血清中的补体C1q与血清中的IgM (r=0.422, P0.01)、C3 (r=0.667,P0.01)、C4 (r=0.480,P0.01)呈正相关。结论1、血清中补体C1q在不同类型的肾病综合征中水平不同,原发性肾病综合征血清补体C1q水平高于继发性。2.在原发性肾病综合征各病理类型中以微小病变者水平升高最为显著。3.膜性肾病肾组织中C1q表达阴性的患者经激素联合环磷酰胺治疗较C1q表达阳性的患者完全缓解率明显增高,总缓解率也较高。提示肾组织中C1q表达有可能作为判断治疗反应的预测指标。
[Abstract]:1. through the detection of adult nephrotic syndrome (Nephrotic, syndrome, NS) in the serum of patients with deposition of complement Clq expression and pathological tissues of Clq, to investigate the expression of Clq and pathological types of glomerular diseases in serum and tissues of patients with renal pathology, etiology correlation; correlation between Clq expression and membranous nephropathy in 2. serum the level of Clq in tissues and, in order to understand the clinical significance and prognostic evaluation of efficacy in membranous nephropathy serum Clq and pathological findings in Clq. Methods 1. clinical data of 266 patients with nephrotic syndrome (NS) patients as the experimental group, all patients in the experimental group were consistent with the diagnostic criteria of nephrotic syndrome for the first time, and the incidence of patients. The patients were also collected information, including gender, age, time of onset, symptoms, disease course, each patient underwent renal biopsy, and check the following: urine routine Blood routine, liver function, renal function, blood glucose, blood lipid, and 24 hour urinary protein, beta 2 microglobulin, immunoglobulin and complement, dsDNA, ANA, SM, ANCA, GBM, virological indicators, blood light chain, immunofixation electrophoresis, detection of tumor markers; in addition, collected from 101 healthy adults as the control group.2. collected all the patients in the experimental group and control group in serum, frozen, after detection of unified C1q; serum Clq: the serum specimens are kept at 2-8 DEG C; the samples were added to the two kit, were incubated for 5 min, read out the data, the calculated results of.3. nephrotic syndrome the patients underwent percutaneous renal biopsy puncture of the kidney tissues by immunofluorescence, light microscopy and electron microscopy of.4. in 195 cases of primary nephrotic syndrome, in membranous nephropathy according to the expression of Clq in renal tissue, a total of 34 cases of Clq patients with positive expression of Clq in 36 cases The expression of negative patients, a total of 70 cases, two groups were treated with prednisone plus cyclophosphamide for 6 months, the follow-up of the two groups were observed; the remission rate is different, in order to understand the clinical significance and prognosis evaluation in membranous nephropathy serum C1q and pathological findings in Clq. 1. and 101 cases of healthy control group (174.5 + 24.4) mg/L and 71 cases of NS patients (170.1 + 35.4) compared to mg/L, 195 cases of primary NS cases serum C1q group (193.1 + 30.8) mg/L significantly increased (P0.01); among them, minimal change disease in patients with serum C1q (215.2 + 36.2 M / / L) was significantly higher than other groups (P0.01).2. in the kidney tissues, the positive rate of C1q in membranous nephropathy (46.3%) was significantly higher than other pathological types (P0.01); the expression of C1q was more than -++ accounted for 19.8% of the renal tissue immunofluorescence; in the diagnosis of primary nephrotic syndrome in 1 cases of C1q nephropathy.3. of 70 cases of primary nephrotic Patients with syndrome in the pathologic types of membranous nephropathy results showed: 36 cases of renal tissue in patients with Clq negative expression after treatment, complete remission rate (50%) was significantly higher than that of patients with positive expression of C1q in renal tissues of 34 cases (17.6%) (P0.05), the total remission rate was slightly increased, but no significant difference complete remission (P=0.13). The level of serum Clq in two cases (169.2+18.6) mg/L was significantly lower than that of partial remission (197.5 + 38.2) and remission (194.2 + 24.1) mg/L.4. in 71 cases of secondary NS in lupus nephritis group, serum C1q (151.4 + 30.3) Clq serum mg/L was significantly lower than other secondary the disease, while the positive expression rate of Clq in renal tissue of 100%.5. in secondary or primary NS patients, was negatively correlated with pathological serum complement C1q in C1q (r=-0.344, P0.01). The serum complement C1q and IgM in (r= 0.422, P0.01, C3) (r=0.667, P0.01), C 4 (r=0.480, P0.01) were positively correlated. Conclusion 1, serum complement C1q in different types of nephrotic syndrome in different levels of primary nephrotic syndrome serum level of C1q was higher than that of secondary.2. in primary nephrotic syndrome in different pathological types of integrated micro lesion levels were the most negative patients steroid and cyclophosphamide treatment than C1q positive patients with complete remission rate significantly increased C1q expression in renal tissue of.3. nephropathy significantly in the membrane, the total remission rate is higher. The expression of C1q in renal tissue that can be used as a marker to predict the response to treatment.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R692

【相似文献】