IgA/C3在IgA肾病中的诊断价值分析
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摘要
目的探讨IgA/C3在IgA肾病中的辅助诊断价值,以及在实际治疗过程中的应用。方法选择2014年5月至2015年7月在该院诊治的肾病患者85例,按免疫分类为IgA组和非IgA组,比较两组患者的IgA、C3和IgA/C3指标;同时将IgA患者按Lee′s肾病等级分为3个亚组,分别比较每组的IgA、C3和IgA/C3指标;另外将IgA与IgA/C3作为IgA肾病诊断效能进行比较。结果其中IgA组患者的IgA为(2.81±0.66)g/L,IgA/C3为3.08±0.97,均高于非IgA组[(1.77±0.41)g/L,1.27±0.41](P<0.05);而C3则低于非IgA组(0.92±0.16 vs.1.44±0.19,P<0.05)。按Lee′s肾病等级分为3个亚组的IgA患者的IgA和IgA/C3的表达均相差较小,差异无统计学意义(P>0.05);IgA与IgA/C3作为IgA肾病诊断效能比较中,IgA/C3的ROC曲线下面积(0.951)和灵敏度(92.48%)均高于IgA(0.806,71.55%)。结论血清IgA/C3比值能够很好地区分非IgA和IgA患者,但是对于IgA肾病严重程度需要更多指标进一步鉴别。
Objective To investigate the diagnostic value of IgA/C3 in IgA nephropathy and its application in practical treatment.Methods From May 2014 to July 2015,85 patients with nephropathy were divided into IgA group and non-IgA group according to immune classification.The IgA,C3 and IgA/C3 indexes of the two groups were compared.At the same time,IgA patients were divided into three subgroups according to Lee′s grade of nephropathy according to IgA group,and IgA,C3 and IgA/C3 were compared in each group,and IgA and IgA/C3 were compared as diagnostic efficacy of IgA nephropathy.Results The IgA and IgA/C3 in IgA group were(2.81±0.66)g/L and 3.08±0.97)g/L,higher than those in non-IgA group [(1.77±0.41)g/L,1.27±0.41),P<0.05],but C3 was lower than that of non-IgA group(0.92±0.16 vs.1.44±0.19,P<0.05).The expression of IgA and IgA/C3 in patients with IgA divided into three subgroups according to Lee′s grade of nephropathy showed no significant difference(P>0.05).The area under the ROC curve of IgA/C3 and sensitivitywere higher than those of IgA(0.951 vs.0.806,92.48% vs.71.55%).Conclusion Serum IgA/C3 can well distinguish between non-IgA and IgA patients,but more indicators are needed to further differentiate the severity of IgA nephropathy.
Objective To investigate the diagnostic value of IgA/C3 in IgA nephropathy and its application in practical treatment.Methods From May 2014 to July 2015,85 patients with nephropathy were divided into IgA group and non-IgA group according to immune classification.The IgA,C3 and IgA/C3 indexes of the two groups were compared.At the same time,IgA patients were divided into three subgroups according to Lee′s grade of nephropathy according to IgA group,and IgA,C3 and IgA/C3 were compared in each group,and IgA and IgA/C3 were compared as diagnostic efficacy of IgA nephropathy.Results The IgA and IgA/C3 in IgA group were(2.81±0.66)g/L and 3.08±0.97)g/L,higher than those in non-IgA group [(1.77±0.41)g/L,1.27±0.41),P<0.05],but C3 was lower than that of non-IgA group(0.92±0.16 vs.1.44±0.19,P<0.05).The expression of IgA and IgA/C3 in patients with IgA divided into three subgroups according to Lee′s grade of nephropathy showed no significant difference(P>0.05).The area under the ROC curve of IgA/C3 and sensitivitywere higher than those of IgA(0.951 vs.0.806,92.48% vs.71.55%).Conclusion Serum IgA/C3 can well distinguish between non-IgA and IgA patients,but more indicators are needed to further differentiate the severity of IgA nephropathy.
引文
[1]祝爽爽,李永强,周树录,等.血清中IgA/C3比值在IgA肾病诊断预测中的价值及其与IgA肾病临床及病理联系[J].南方医科大学学报,2015,35(12):1683-1688.
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[5]李卅立,范秋灵,赵洁,等.IgA肾病牛津分型与临床指标的相关性及危险因素分析[J].中国医科大学学报,2017,46(1):1-6.
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[9]ZOU J,XIAO J,HU S,et al.Toll-like Receptor 4Signaling Pathway in the Protective Effect of Pioglitazone on Experimental Immunoglobulin A Nephropathy[J].Chin Med J(Engl),2017,130(8):906-913.
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[11]SATO M,ADACHI M,KOSUKEGAWA H,et al.The size of palatine tonsils cannot be used to decide the indication of tonsillectomy for IgA nephropathy[J].Clin Kidney J,2017,10(2):221-228.
[12]张亚莉,冯婕,姜莎莎,等.老年患者IgA肾病的临床与病理分析[J].中国老年学杂志,2014,34(10):2706-2708.
[13]侯静,刘勇,刘进,等.血清生化指标与老年肾病患者肾脏病理的相关性[J].中国老年学杂志,2014,34(20):5754-5756.
[14]唐仕超,王赓,张志国,等.补体C3、补体C4和C反应蛋白在系统性红斑狼疮活动和感染中的临床价值[J].第二军医大学学报,2016,37(4):397-400.
[15]于霞,吴萍,林芙君等.IgA肾病患者TANK结合激酶1基因多态性与临床和病理表型的关系[J].上海医学,2014,37(5):394-397.
[16]ZHANG J,WANG C,TANG Y,et al.Serum immunoglobulin A/C3ratio predicts progression of immunoglobulin A nephropathy[J].Nephrology(Carlton),2013,18(2):125-131.
[2]刘璐,陈铖,严苗.IgA/C3对IgA肾病的辅助诊断价值[J].山东医药,2016,56(24):96-98.
[3]田寿福,费梅,陈爱平,等.血清补体C3在IgA肾病中的作用[J].中国老年学杂志,2014,34(24):6925-6927.
[4]樊平,戴双明,邹川,等.I gA肾病的临床表现与病理特征研究[J].西安交通大学学报(医学版),2015,02(2):241-244.
[5]李卅立,范秋灵,赵洁,等.IgA肾病牛津分型与临床指标的相关性及危险因素分析[J].中国医科大学学报,2017,46(1):1-6.
[6]周悦玲,蒋更如.IgA肾病进展至终末期肾病临床预测的研究现状[J].上海交通大学学报(医学版),2016,36(2):296-301.
[7]曾彩虹.梅奥诊所/肾脏病理学会关于肾小球肾炎病理分类、诊断及报告共识[J].肾脏病与透析肾移植杂志,2016,25(3):261-268.
[8]杨晓峰,王晓英,刘春忻.IgA肾病患者感染后肾小球肾炎的病理与临床预后研究[J].中华医院感染学杂志,2015,25(15):3485-3487.
[9]ZOU J,XIAO J,HU S,et al.Toll-like Receptor 4Signaling Pathway in the Protective Effect of Pioglitazone on Experimental Immunoglobulin A Nephropathy[J].Chin Med J(Engl),2017,130(8):906-913.
[10]张炜,吴永贵,梁维龙,等.IgA肾病高尿酸血症与牛津病理分型及临床特征[J].临床与实验病理学杂志,2014,30(9):1007-1010.
[11]SATO M,ADACHI M,KOSUKEGAWA H,et al.The size of palatine tonsils cannot be used to decide the indication of tonsillectomy for IgA nephropathy[J].Clin Kidney J,2017,10(2):221-228.
[12]张亚莉,冯婕,姜莎莎,等.老年患者IgA肾病的临床与病理分析[J].中国老年学杂志,2014,34(10):2706-2708.
[13]侯静,刘勇,刘进,等.血清生化指标与老年肾病患者肾脏病理的相关性[J].中国老年学杂志,2014,34(20):5754-5756.
[14]唐仕超,王赓,张志国,等.补体C3、补体C4和C反应蛋白在系统性红斑狼疮活动和感染中的临床价值[J].第二军医大学学报,2016,37(4):397-400.
[15]于霞,吴萍,林芙君等.IgA肾病患者TANK结合激酶1基因多态性与临床和病理表型的关系[J].上海医学,2014,37(5):394-397.
[16]ZHANG J,WANG C,TANG Y,et al.Serum immunoglobulin A/C3ratio predicts progression of immunoglobulin A nephropathy[J].Nephrology(Carlton),2013,18(2):125-131.