狼疮性肾炎患者肾组织中抗-C1q抗体与疾病活动性之间的关系

发布时间：2019-01-08 09:27

【摘要】：目的：探讨狼疮性肾炎(LN)患者肾组织中抗-Clq抗体(C1qAb)与系统性红斑狼疮肾损害的相关性及组织中抗AnuA、抗-dsDNA抗体、ANCA、ANA及抗Sm抗体等自身抗体与狼疮性肾炎疾病活动性的关系,结合其他活动性指标的相关分析,单独或联合检测在狼疮性肾炎诊断中的价值,抗-Clq抗体在狼疮性肾炎不同分型的表达,不同程度抗-Clq抗体在疾病狼疮性肾炎疾病活动性的关系。方法：检测129例行肾穿活检患者,根据是否出现抗-C1q抗体,分为抗-C1q抗体阳性组(n=64例)及抗-Clq抗体阴性组(n=65例),同时记录系统性红斑狼疮患者的各种临床表现,检测其他自身抗体(抗核小体抗体、抗核抗体、抗dsDNA抗体、抗中性粒细胞抗体、抗Sm抗体)和相关实验室指标(血细胞计数、血沉、补体、24小时尿蛋白定量、肾功能等)。结果：抗-Clq抗体与年龄、病程、血沉、血清球蛋白、血清尿素氮、血清肌酐无相关性。与补体C3、补体C4、、血红蛋白、血清白蛋白呈负相关性；与24小时尿蛋白定量、肾小球率过滤、甘油三酯、SLEDAI评分呈正相关性。与抗-dsDNA抗体、抗-Sm抗体、抗核抗体、抗核小体抗体、抗中性粒细胞抗体这五种自身抗体有一致性。对活动性狼疮性肾炎的诊断以抗-Clq抗体+抗核小体抗体抗体联合检测的方案为优。抗-Clq抗体与SLEDAI评分、AI评分有显著正相关性,Ⅲ型及Ⅳ型狼疮性肾炎患者组织中抗-C1q抗体表达高于其他分型,故被认为强活动性。阳性程度的增加,活动性越强。抗-C1q抗体(++)组患者血清补体水平显著降低；抗-C1q抗体(+++)组患者患有更重的低补体血症、SLEDAI评分和AI评分的逐渐增加、肾小球率过滤的逐渐下降,肾功能损害的危险更大。结论：抗Clq抗体在系统性红斑狼疮患者肾脏损害的发生,发展中起重要的作用,与肾脏病变程度及疾病活动性有密切的相关性,在LN的诊断中有重要意义。
[Abstract]:Objective: to investigate the relationship between anti-Clq antibody (C1qAb) in renal tissue and renal damage in systemic lupus erythematosus (SLE) in patients with lupus nephritis (LN) and the anti-AnuA, anti-dsDNA antibody (ANCA,) in tissues of patients with lupus nephritis. The relationship between autoantibodies such as ANA and anti Sm antibodies and the activity of lupus nephritis. Combined with the correlation analysis of other active indexes, the value of single or combined detection in the diagnosis of lupus nephritis. The expression of anti-Clq antibody in different types of lupus nephritis and the relationship between anti-Clq antibody and disease activity of lupus nephritis. Methods: according to the presence of anti-C1q antibody, 129 renal biopsy patients were divided into two groups: 64 patients with positive anti-C1q antibody and 65 patients with negative anti-C1q antibody. The clinical manifestations of patients with systemic lupus erythematosus were recorded. Other autoantibodies (anti-nucleosome antibody, antinuclear antibody, anti-dsDNA antibody, anti-neutrophil antibody, anti-Sm antibody) and related laboratory indexes (blood cell count, erythrocyte sedimentation rate, complement, 24 hours urine protein quantification, renal function, etc.) were detected. Results: there was no correlation between anti-Clq antibody and age, course of disease, erythrocyte sedimentation rate, serum globulin, serum urea nitrogen, serum creatinine. There was a negative correlation with complement C _ 3, complement C _ 4, hemoglobin and serum albumin, and a positive correlation with 24 hour urinary protein quantification, glomerular filtration, triglyceride and SLEDAI score. It is consistent with five autoantibodies: anti-dsDNA antibody, anti-Sm antibody, anti-nucleosome antibody and anti-neutrophil antibody. In the diagnosis of active lupus nephritis, the combined detection of anti-Clq antibody and anti nucleosome antibody was the best. There was a significant positive correlation between anti-C1q antibody and SLEDAI score and AI score. The expression of anti-C1q antibody in type 鈪，

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