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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(P<0.05)。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(P<0.05)。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(P<0.05)。(2)5年肾脏生存率50.8%,IgG(-)和IgG(+)组分别为60%和36.4%(P<0.01);C3(-)和C3(+)分别为53.5%和43%(P<0.01)。(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。
Objective: To retrospectively analyze the correlation between the renal deposition of IgG and C3 in patients with diabetic nephropathy (DN) and its clinical manifestation and prognosis. Methods: A total of 460 patients with DN diagnosed by renal biopsy in the Nanjing General Hospital of Nanjing Military Region from 2003 to 2013 were selected to investigate the relationship between the deposition of IgG and C3 in renal tissue and the prognosis. Results: (1) According to IgG deposition, they were divided into IgG (+) and IgG (-) groups. The IgG (+) group had longer duration of diabetes, more urinary protein, higher mean arterial pressure, higher serum creatinine and glycosylated hemoglobin, higher triglyceride treatment, higher rates of retinopathy and peripheral neuropathy, higher serum albumin and serum calcium , The estimated glomerular filtration rate (e GFR) was lower (P <0.05). Tubular atrophy and interstitial fibrosis, interstitial inflammation and arteriosclerosis in IgG (+) group were significantly higher than those in IgG (-) group (P <0.05). There was a long course of diabetes mellitus and kidney disease in C3 (+) group, mean arterial pressure, serum creatinine, urinary protein and retinopathy were higher in C3 (+) and C3 (- ). (5) The 5-year renal survival rate was 50.8%, while the IgG (-) and IgG (+) groups were 60% and 36.4% (P <0.01). (3) Univariate regression analysis showed that the duration of diabetes, retinopathy, mean arterial pressure, urinary protein, hemoglobin, serum albumin, serum creatinine, glycosylated hemoglobin, glomerular grading, tubular atrophy and interstitial fibrosis Interstitial inflammation, renal deposition of IgG and C3 have a significant impact on prognosis. Multivariate regression analysis showed that HbA1c, total cholesterol, urinary protein, serum creatinine, IFTA and retinopathy were independent risk factors for prognosis after adjusting for clinical and pathological factors. Conclusion: DN patients with positive IgG or complement C3 were found to be clinically The performance is more serious, the prognosis is worse, but neither IgG nor C3 deposition is an independent risk factor for poor prognosis in the kidney.