血清IgA、IgA/C3和IgA/C4比值在IgA型肾病临床鉴别诊断中的应用
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摘要
目的:探讨血清IgA、IgA/C3和IgA/C4比值水平在原发性IgA肾病与非IgA型肾病鉴别诊断中的价值。方法:收集经肾穿刺病理检测确诊的IgA型肾病64例和非IgA型肾病67例血清样本,用免疫比浊法检测病人血清IgA、C3与C4水平,并计算IgA/C3、IgA/C4的比值。通过绘制ROC曲线,并计算曲线下面积,比较血清IgA、IgA/C3和IgA/C4在预测IgA肾病的价值。结果:原发性IgA肾病病人血清IgA、IgA/C3和IgA/C4比值较其他肾小球性疾病组明显升高(P<0.01),IgA、IgA/C3和IgA/C4比值的ROC曲线下面积分别为0.692、0.718和0.747。结论:在无肾穿刺病理诊断的条件下,IgA和IgA/C3及IgA/C4比值在原发性IgA肾病鉴别诊断中可起一定辅助作用。
Objective: To investigate the value of the serum IgA,ratios of IgA/C3 and IgA/C4 in the differential diagnosis of primary IgA nephropathy and non-IgA nephropathy. Methods: The serum levels of IgA,C3 and C4 in 64 IgA nephropathy patients and 67 nonIgA nephropathy patients were detected using turbidimetric immunoassay,the ratios of IgA/C3 and IgA/C4 were calculated,the ROC curve were established,and the area under the curve was calculated. The significance of the serum IgA,ratios of IgA/C3 and IgA/C4 in predicting the IgA nephropathy was evaluated. Results: The serum IgA level,ratios of IgA/C3 and IgA/C4 in patients with primary IgA nephropathy significantly increased compared with other nephrotic patients( P < 0. 01),and the area under the ROC curve of the IgA,ratios of IgA/C3 and IgA/C4 was 0. 692,0. 718 and 0. 747,respectively. Conclusions: In the absence of pathological diagnosis of renal biopsy,the IgA,ratios of IgA/C3 and IgA/C4 can play an auxiliary role in the differential diagnosis of primary IgA nephropathy.
Objective: To investigate the value of the serum IgA,ratios of IgA/C3 and IgA/C4 in the differential diagnosis of primary IgA nephropathy and non-IgA nephropathy. Methods: The serum levels of IgA,C3 and C4 in 64 IgA nephropathy patients and 67 nonIgA nephropathy patients were detected using turbidimetric immunoassay,the ratios of IgA/C3 and IgA/C4 were calculated,the ROC curve were established,and the area under the curve was calculated. The significance of the serum IgA,ratios of IgA/C3 and IgA/C4 in predicting the IgA nephropathy was evaluated. Results: The serum IgA level,ratios of IgA/C3 and IgA/C4 in patients with primary IgA nephropathy significantly increased compared with other nephrotic patients( P < 0. 01),and the area under the ROC curve of the IgA,ratios of IgA/C3 and IgA/C4 was 0. 692,0. 718 and 0. 747,respectively. Conclusions: In the absence of pathological diagnosis of renal biopsy,the IgA,ratios of IgA/C3 and IgA/C4 can play an auxiliary role in the differential diagnosis of primary IgA nephropathy.
引文
[1]ROBERT T,BERTHELOT L,CAMBIER A,et al.Molecular insights into the pathogenesis of Ig A nephropathy[J].Trends Mol Med,2015,21(12):762.
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[5]汤颖,马小琨,张俊,等.血清Ig A,C3及Ig A/C3与Ig A肾病诊断及病理分级的关系[J].中华全科医学,2010,8(1):17.
[6]KOMATSU H,FUJIMOTO S,HARA S,et al.Relationship between serum Ig A/C3 ratio and progression of Ig A nephropathy[J].Int Med,2004,43(11):1023.
[7]祝爽爽,李永强,周树录,等.血清中Ig A/C3比值在Ig A肾病诊断预测中的价值及其与Ig A肾病临床及病理联系[J].南方医科大学学报,2015,35(12):1683.
[8]刘林林,刘楠,王娟,等.肾小球C4d沉积为Ig A肾病的预后因子[J].中国医科大学学报,2017,46(1):23.
[9]吴春林.肾病病人免疫球蛋白、补体、白蛋白、血脂与肾脏病理的关系[J].检验医学,2013,28(5):370.
[2]WYATT RJ,JULIAN BA.Ig A nephropathy[J].N Engl J Med,2013,368(25):2402.
[3]SAKAI H,ABE K,KOBAYASHI Y,et al.Clinical guidelines of Ig A nephropathy[J].Nihon Jinzo Gakkai Shi,1995,37(8):417.
[4]付莎,徐安平,李劲高.血清Ig A及Ig A/C3比值用于Ig A肾病的诊断价值——附180例报告[J].新医学,2010(10):658.
[5]汤颖,马小琨,张俊,等.血清Ig A,C3及Ig A/C3与Ig A肾病诊断及病理分级的关系[J].中华全科医学,2010,8(1):17.
[6]KOMATSU H,FUJIMOTO S,HARA S,et al.Relationship between serum Ig A/C3 ratio and progression of Ig A nephropathy[J].Int Med,2004,43(11):1023.
[7]祝爽爽,李永强,周树录,等.血清中Ig A/C3比值在Ig A肾病诊断预测中的价值及其与Ig A肾病临床及病理联系[J].南方医科大学学报,2015,35(12):1683.
[8]刘林林,刘楠,王娟,等.肾小球C4d沉积为Ig A肾病的预后因子[J].中国医科大学学报,2017,46(1):23.
[9]吴春林.肾病病人免疫球蛋白、补体、白蛋白、血脂与肾脏病理的关系[J].检验医学,2013,28(5):370.