C4d和CD3对IgA肾病预后的预测价值
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摘要
目的探讨补体片段C4d和T细胞标记物CD3对IgA肾病患者的预后价值。方法 2010年1月至2012年12月,我院收治经肾脏穿刺活检病理确诊IgA肾病患者80例,采用免疫组织化学(IHC)检测穿刺标本C4d和CD3的表达。并对患者进行4年的随访,根据随访结果分为进展期肾病和非进展期肾病。比较C4d和CD3对肾脏存活率的影响,比较C4d,CD3,临床病理学参数与患者预后的相关性。结果总计24例患者随访期间发展为进展期肾病,高血压、eGFR、蛋白尿、牛津病理分型T1-2、C4d、CD3与进展期肾病相关(P<0.05)。C4d阳性患者肾脏存活率显著低于C4d阴性患者(P<0.05);多变量回归分析表明eGFR、C4d、CD3水平为影响患者预后的独立危险因素。结论C4d,CD3与IgA肾病患者预后较差相关,可作为判断患者预后不良的标记物。
Objective To investigate the prognostic value of complement fragment C4 dand T cell marker CD3 in IgA nephropathy patients.Methods from January 2010 to December 2012,80 patients with IgA nephropathy were diagnosed by renal biopsy in our hospital.Immunohistochemistry(IHC)was used to detect the expression of C4 dand CD3 in the puncture specimens.The patients were followed up for 4 years.They were divided into progressive nephropathy group and non progressive nephropathy group according to the follow-up results,compare the effect of C4 dand CD3 on renal survival,the correlation between C4 d,CD3,clinicopathological parameters and prognosis of patients.Results A total of 24 patients developed progressive kidney disease during the follow-up.Hypertension,eGFR,proteinuria,and pathological subtypes of T1-2,C4 d,and CD3 were associated with progressive nephropathy(P<0.05).The renal survival rate in C4 dpositive patients was significantly lower than C4 dnegative patients(P<0.05);multivariate regression analysis showed that eGFR and C4 d,CD3 levels were independent risk factors that affecting the prognosis of patients.Conclusion C4 dand CD3 were associated with poor prognosis in IgA nephropathy patients,and can be a powerful predictor of IgAN progression
Objective To investigate the prognostic value of complement fragment C4 dand T cell marker CD3 in IgA nephropathy patients.Methods from January 2010 to December 2012,80 patients with IgA nephropathy were diagnosed by renal biopsy in our hospital.Immunohistochemistry(IHC)was used to detect the expression of C4 dand CD3 in the puncture specimens.The patients were followed up for 4 years.They were divided into progressive nephropathy group and non progressive nephropathy group according to the follow-up results,compare the effect of C4 dand CD3 on renal survival,the correlation between C4 d,CD3,clinicopathological parameters and prognosis of patients.Results A total of 24 patients developed progressive kidney disease during the follow-up.Hypertension,eGFR,proteinuria,and pathological subtypes of T1-2,C4 d,and CD3 were associated with progressive nephropathy(P<0.05).The renal survival rate in C4 dpositive patients was significantly lower than C4 dnegative patients(P<0.05);multivariate regression analysis showed that eGFR and C4 d,CD3 levels were independent risk factors that affecting the prognosis of patients.Conclusion C4 dand CD3 were associated with poor prognosis in IgA nephropathy patients,and can be a powerful predictor of IgAN progression
引文
[1]Salvadori M,Rosso G.Update on immunoglobulin a nephropathy.Part II:Clinical,diagnostic and therapeutical aspects[J].World J Nephrol,2016,5(1):6.
[2]Salvadori M,Rosso G.Update on immunoglobulin A nephropathy,Part I:Pathophysiology[J].World Journal of Nephrology,2015,4(4):455.
[3]Floege J,Eitner F.Current therapy for IgA nephropathy[J].J Am Soc Nephrol,2011,22(10):1785.
[4]Eitner F,Ackermann D,Hilgers R D,et al.IgA-Nephropathie[J].Der Nephrologe,2008,3(4):315.
[5]Wyatt R J,Julian B A.IgA nephropathy[J].N Engl J Med,2013,368(25):2402.
[6]Cattran D C,Coppo R,Cook H T,et al.The Oxford classification of IgA nephropathy:rationale,clinicopathological correlations,and classification[J].Kidney Int,2009,76(5):534.
[7]Daha M R,van Kooten C.Deposition of IgA in primary IgA nephropathy:it takes at least four to tango[J].Nephrol Dial Transplant,2013,28(4):794.
[8]Xu X M,Zhu S S,Wang X H,et al.Clinical and pathological features in IgA nephropathy with IgG deposition in the glomerular mesangial area[J].Journal of Southern Medical University,2017,37(3):308.
[9]Myllymaki J M,Honkanen T T,Syrjanen J T,et al.Severity of tubulointerstitial inflammation and prognosis in immunoglobulin A nephropathy[J].Kidney Int,2007,71(4):343.
[10]刘林林,刘楠,王娟,等.肾小球C4d沉积为IgA肾病的预后因子[J].中国医科大学学报,2017,46(1):23.
[11]Cattran D C,Coppo R,Cook H T,et al.The Oxford classification of IgA nephropathy:rationale,clinicopathological correlations,and classification[J].Kidney Int,2009,76(5):534.
[12]Espinosa M,Ortega R,Gomez-Carrasco J M,et al.Mesangial C4ddeposition:a new prognostic factor in IgA nephropathy[J].Nephrol Dial Transplant,2009,24(3):886.
[13]Myllymaki J M,Honkanen T T,Syrjanen J T,et al.Severity of tubulointerstitial inflammation and prognosis in immunoglobulin A nephropathy[J].Kidney Int,2007,71(4):343.
[14]彭用华.牛津分型病理指标的预测价值及IgA肾病危险因素分级研究[D].北京协和医学院,中国医学科学院,北京协和医学院,清华大学医学部,中国医学科学院,2012.
[15]Masutani K,Tsuchimoto A,Yamada T,et al.Comparison of steroid-pulse therapy and combined with mizoribine in IgA nephropathy:a randomized controlled trial[J].Clinical&Experimental Nephr ology,2016,20(6):896.
[16]Al H T,Hussein M H,Al M H,et al.Pathophysiology of IgA Nephropathy.[J].Advances in Anatomic Pathology,2017,24(1):56.
[2]Salvadori M,Rosso G.Update on immunoglobulin A nephropathy,Part I:Pathophysiology[J].World Journal of Nephrology,2015,4(4):455.
[3]Floege J,Eitner F.Current therapy for IgA nephropathy[J].J Am Soc Nephrol,2011,22(10):1785.
[4]Eitner F,Ackermann D,Hilgers R D,et al.IgA-Nephropathie[J].Der Nephrologe,2008,3(4):315.
[5]Wyatt R J,Julian B A.IgA nephropathy[J].N Engl J Med,2013,368(25):2402.
[6]Cattran D C,Coppo R,Cook H T,et al.The Oxford classification of IgA nephropathy:rationale,clinicopathological correlations,and classification[J].Kidney Int,2009,76(5):534.
[7]Daha M R,van Kooten C.Deposition of IgA in primary IgA nephropathy:it takes at least four to tango[J].Nephrol Dial Transplant,2013,28(4):794.
[8]Xu X M,Zhu S S,Wang X H,et al.Clinical and pathological features in IgA nephropathy with IgG deposition in the glomerular mesangial area[J].Journal of Southern Medical University,2017,37(3):308.
[9]Myllymaki J M,Honkanen T T,Syrjanen J T,et al.Severity of tubulointerstitial inflammation and prognosis in immunoglobulin A nephropathy[J].Kidney Int,2007,71(4):343.
[10]刘林林,刘楠,王娟,等.肾小球C4d沉积为IgA肾病的预后因子[J].中国医科大学学报,2017,46(1):23.
[11]Cattran D C,Coppo R,Cook H T,et al.The Oxford classification of IgA nephropathy:rationale,clinicopathological correlations,and classification[J].Kidney Int,2009,76(5):534.
[12]Espinosa M,Ortega R,Gomez-Carrasco J M,et al.Mesangial C4ddeposition:a new prognostic factor in IgA nephropathy[J].Nephrol Dial Transplant,2009,24(3):886.
[13]Myllymaki J M,Honkanen T T,Syrjanen J T,et al.Severity of tubulointerstitial inflammation and prognosis in immunoglobulin A nephropathy[J].Kidney Int,2007,71(4):343.
[14]彭用华.牛津分型病理指标的预测价值及IgA肾病危险因素分级研究[D].北京协和医学院,中国医学科学院,北京协和医学院,清华大学医学部,中国医学科学院,2012.
[15]Masutani K,Tsuchimoto A,Yamada T,et al.Comparison of steroid-pulse therapy and combined with mizoribine in IgA nephropathy:a randomized controlled trial[J].Clinical&Experimental Nephr ology,2016,20(6):896.
[16]Al H T,Hussein M H,Al M H,et al.Pathophysiology of IgA Nephropathy.[J].Advances in Anatomic Pathology,2017,24(1):56.