三条补体通路在IgA肾病中的活化及致病作用探讨

发布时间：2018-07-05 11:16

  本文选题：IgA肾病 + 补体活化　； 参考：《青岛大学》2014年硕士论文

【摘要】：目的：研究不同的补体活化类型在IgA肾病(IgA Nephropathy, IgAN)患者血液及尿液中的活化及其致病作用,拓展IgAN的发病机制理论。 方法：疾病组IgAN患者30例,疾病阳性对照组狼疮性肾炎(Lupus Nephritis, LN)患者8例,本院查体中心30例健康人作正常对照组。采用商品化的ELISA试剂盒检测IgAN患者及对照组血清中三条补体激活途径的标志性成分：三条补体活化通路中的共同裂解产物C3a、C5a,及可溶型终末期膜攻击复合物sC5b-9,补体经典途径标志物Clq,凝集素途径标志物L-ficolin (FCN2),经典途径及凝集素途径激活后的共同产物C4d,补体替代途径激活标志产物Bb因子,并检测尿液中的补体经典途径标志物Clq。将IgAN组按照肾脏病理的Lee氏分级进行分组,Lee氏Ⅰ-Ⅲ级为一组,Lee氏Ⅳ-Ⅴ级定为损伤较重的组,比较两组间的补体激活差异。分析三条途径补体激活的差异与肾组织病理结果及临床生化指标的相关性。 结果：在IgAN、LN和正常对照组中,上述检测的补体因子呈现出显著差异(P0.05)。三条补体通路共同产物C3a、C5a及sC5b-9在IgAN组与LN组间无差异,除C5a外,IgAN组和LN组水平均高于正常对照组,差异有统计学意义(P0.05)。IgAN组血清Clq、尿液Clq浓度均较正常对照组明显升高,差异有统计学意义(P0.05),IgAN组的尿液Clq水平明显低于LN组(P0.05)。IgAN组与LN组的FCN2水平均明显高于正常对照组,差异有统计学意义(P0.05),此两组间比较无差别。C4d三组间两两比较均有统计学差异(P＜0.05),IgAN组与LN组皆明显高于正常对照组。IgAN患者Lee氏Ⅳ-Ⅴ级组的血液及尿液Clq均明显低于Lee氏Ⅰ～Ⅲ级组(P0.05)。补体因子与临床指标间存在不同程度的相关性,其中Bb、C3a等补体裂解产物与血清肌酐间呈正相关关系(r=0.551, P=0.041; r=0.547, P=0.008),FCN2与尿红细胞计数间呈正相关关系(r=0.416,P=0.025),尿Clq与血清肌酐间呈显著正相关(r=0.518,P=0.033)。 结论：IgAN患者血液中存在着补体替代途径及凝集素途径的活化,可能存在着补体经典途径的活化,补体激活参与临床及肾脏病理损伤,补体激活程度影响临床及病理损伤程度。
[Abstract]:Objective: to study the activation and pathogenicity of different types of complement activation in blood and urine of patients with IgA nephropathy (IgAN), and to explore the pathogenesis of IgAN. Methods: 30 patients with IgAN in the disease group, 8 patients with lupus nephritis (LN) in the positive control group and 30 healthy persons in the examination center of our hospital served as the normal control group. Commercial Elisa kit was used to detect the signature components of three complement activation pathways in IgAN patients and control group: the co-cleavage product C3aOC5afrom three complement activation pathways, and soluble end-stage membrane attack complex sC5b-9, complement. Classical pathway marker Clq, agglutinin pathway marker L-ficolin (FCN2), common product C4d after activation of classical pathway and lectin pathway, Bb factor, activation marker of complement substitution pathway, The classical complement pathway marker Clq. in urine was also detected. According to the Lee's grade of renal pathology, IgAN group was divided into two groups: Lee's grade 鈪，

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