肾组织IgG和C3沉积与糖尿病肾病预后的关联

发布时间：2019-03-01 14:09

【摘要】：目的:回顾性分析糖尿病肾病(DN)患者肾组织IgG及C3沉积与临床表现及预后的相关性。方法:选取2003年至2013年在南京军区南京总医院肾脏科行肾活检明确诊断DN的患者共460例,观察肾组织IgG和C3沉积情况与预后的相关性。结果:(1)按IgG沉积分为IgG(+)和IgG(-)组。IgG(+)组糖尿病病程更长、尿蛋白更多,平均动脉压、血清肌酐、糖化血红蛋白更高,雷公藤多苷治疗、视网膜病变率及外周神经病变率更高,血清白蛋白、血钙、估算的肾小球滤过率(e GFR)更低(P0.05)。IgG(+)组的肾小管萎缩与间质纤维化、间质炎症程度、动脉硬化程度明显高于IgG(-)组(P0.05)。按C3沉积分为C3(+)和C3(-)组:C3(+)组糖尿病及肾脏病病程较长,平均动脉压、血清肌酐、尿蛋白定量、视网膜病变率均较高(P0.05)。(2)5年肾脏生存率50.8%,IgG(-)和IgG(+)组分别为60%和36.4%(P0.01);C3(-)和C3(+)分别为53.5%和43%(P0.01)。(3)单因素回归分析显示糖尿病病程、视网膜病变、平均动脉压、尿蛋白、血红蛋白、血清白蛋白、血清肌酐、糖化血红蛋白、肾小球分级、肾小管萎缩与间质纤维化(IFTA)、间质炎症、肾组织IgG和C3沉积对预后均有显著影响。多因素回归分析校正临床及病理相关因素后,糖化血红蛋白、总胆固醇、尿蛋白、血清肌酐、IFTA及视网膜病变是影响预后的独立风险因素,结论:DN患者肾组织IgG阳性或补体C3阳性者临床表现更重,预后更差,但IgG或C3沉积均不是肾脏预后不佳的独立危险因素。
[Abstract]:Objective: to retrospectively analyze the relationship between the deposition of IgG and C3 in renal tissue and clinical manifestation and prognosis in patients with diabetic nephropathy (DN). Methods: from 2003 to 2013, a total of 460 patients with DN were diagnosed by renal biopsy in Nanjing General Hospital of Nanjing military region. The relationship between the deposition of IgG and C3 in renal tissue and prognosis was observed. Results: (1) according to the deposition of IgG, they were divided into IgG () and IgG (-) groups. The duration of diabetes mellitus was longer, the urine protein was higher, the mean arterial pressure, serum creatinine, glycosylated hemoglobin were higher in group IgG (鈪，

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