摘要
目的了解老年特发性膜性肾病(IMN)患者血清C3d、C5b-9水平及其与预后的相关性。方法回顾性收集2015年1月至2017年5月在郑州大学第一附属医院肾脏内科经肾穿刺活检确诊为IMN的老年患者(老年组)231例、非老年IMN患者(非老年组)96例,选取同期在郑州大学第一附属医院的健康老年体检者(健康对照组)118例。按照血清C3d中位数水平分为低(112例)、高C3d(113例)水平组,应用酶联免疫吸附法检测各组血清C3d和C5b-9水平。结果老年IMN组血清C3d和C5b-9水平分别为0.23(0.15,0.45)mg/L、0.28(0.20,1.23)mg/L,高于健康对照组[0.18(0.13,0.22)mg/L、0.22(0.16,0.26)mg/L](Z=-4.261、-6.213,均P<0.001)。老年和(或)非老年IMN组患者血清C3d与估算的肾小球滤过率呈负相关(r=-0.155、-0.426,P=0.019、0.000),与血清肌酐、抗M型磷脂酶A2受体(PLA2R)抗体、24 h尿蛋白定量呈正相关(r=0.184、0.326、0.407、0.321、0.145,P=0.005、0.001、0.000、0.001、0.027)。Kaplan-Meier生存曲线分析显示,老年IMN组高C3d水平组肾脏累积生存率47.8%,显著低于低C3d组70.8%(Log Rankχ^(2)=7.399、P=0.007)。多因素Cox回归分析结果显示,高C3d水平是老年IMN患者肾脏不良预后的独立危险因素(HR=2.288,95%CI:1.082~4.839,P=0.030)。结论高血清C3d和C5b-9中仅前者与老年IMN患者尿蛋白排泄和血清抗PLA2R抗体水平增高、肾功能下降及疾病不良预后相关。
Objective To investigate changes in serum C3d and C5b-9 levels in elderly patients with idiopathic membranous nephropathy(IMN)and their correlations with prognosis.Methods Two hundred thirty-one elderly patients with IMN and 96 non-elderly patients with IMN confirmed by kidney biopsy at the First Affiliated Hospital of Zhengzhou University from January 2015 to May 2017 were enrolled.During the same period,118 healthy individuals receiving health checkups were included as controls.Patients were divided into the low C3d group(n=112)and the high C3d group(n=113)according to the median level of serum C3d.Serum C3d and C5b-9 levels were measured by enzyme-linked immunosorbent assays.Results Serum C3d and C5b-9 levels in elderly IMN patients were 0.23(0.15,0.45)mg/L and 0.28(0.20,1.23)mg/L,respectively,which were higher than those in healthy controls[0.18(0.13,0.22)mg/L,0.22(0.16,0.26)mg/L,respectively](Z=-4.261 and-6.213,P<0.001).Serum C3d levels in elderly and non-elderly IMN patients were correlated negatively with the estimated glomerular filtration rate(r=-0.155 and-0.426,P=0.019 and 0.000),but positively with serum creatinine,anti-phospholipase A2 receptor(PLA2R)antibody levels and 24 h urinary protein(r=0.184,0.326,0.407,0.321 and 0.145,P=0.005,0.001,0.000,0.001 and 0.027).Kaplan-Meier survival analysis showed that the cumulative renal survival rate in elderly IMN patients was lower in the high C3d group than in the low C3d group(47.8%vs.70.8%,Log Rankχ^(2)=7.399,P=0.007).Multivariate Cox regression analysis showed that high C3d levels were an independent risk factor for poor renal outcomes in elderly IMN patients(HR=2.288,95%CI:1.082-4.839,P=0.030).Conclusions High serum C3d levels are associated with increases in urinary protein excretion and anti-PLA2R antibody levels,renal function decline,and poor renal outcomes in elderly IMN patients.
作者
文璐
汲凤平
文一博
王晓阳
赵占正
Wen Lu;Ji Fengping;Wen Yibo;Wang Xiaoyang;Zhao Zhanzheng(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Urology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Clinical Systems Biology Laboratories,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2021年第10期1245-1249,共5页
Chinese Journal of Geriatrics
基金
国家自然科学基金(81873611)。
