【摘要】：目的:回顧性分析糖尿病腎病(DN)患者腎組織IgG及C3沉積與臨床表現(xiàn)及預(yù)后的相關(guān)性。方法:選取2003年至2013年在南京軍區(qū)南京總醫(yī)院腎臟科行腎活檢明確診斷DN的患者共460例,觀察腎組織IgG和C3沉積情況與預(yù)后的相關(guān)性。結(jié)果:(1)按IgG沉積分為IgG(+)和IgG(-)組。IgG(+)組糖尿病病程更長(zhǎng)、尿蛋白更多,平均動(dòng)脈壓、血清肌酐、糖化血紅蛋白更高,雷公藤多苷治療、視網(wǎng)膜病變率及外周神經(jīng)病變率更高,血清白蛋白、血鈣、估算的腎小球?yàn)V過(guò)率(e GFR)更低(P0.05)。IgG(+)組的腎小管萎縮與間質(zhì)纖維化、間質(zhì)炎癥程度、動(dòng)脈硬化程度明顯高于IgG(-)組(P0.05)。按C3沉積分為C3(+)和C3(-)組:C3(+)組糖尿病及腎臟病病程較長(zhǎng),平均動(dòng)脈壓、血清肌酐、尿蛋白定量、視網(wǎng)膜病變率均較高(P0.05)。(2)5年腎臟生存率50.8%,IgG(-)和IgG(+)組分別為60%和36.4%(P0.01);C3(-)和C3(+)分別為53.5%和43%(P0.01)。(3)單因素回歸分析顯示糖尿病病程、視網(wǎng)膜病變、平均動(dòng)脈壓、尿蛋白、血紅蛋白、血清白蛋白、血清肌酐、糖化血紅蛋白、腎小球分級(jí)、腎小管萎縮與間質(zhì)纖維化(IFTA)、間質(zhì)炎癥、腎組織IgG和C3沉積對(duì)預(yù)后均有顯著影響。多因素回歸分析校正臨床及病理相關(guān)因素后,糖化血紅蛋白、總膽固醇、尿蛋白、血清肌酐、IFTA及視網(wǎng)膜病變是影響預(yù)后的獨(dú)立風(fēng)險(xiǎn)因素,結(jié)論:DN患者腎組織IgG陽(yáng)性或補(bǔ)體C3陽(yáng)性者臨床表現(xiàn)更重,預(yù)后更差,但I(xiàn)gG或C3沉積均不是腎臟預(yù)后不佳的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to retrospectively analyze the relationship between the deposition of IgG and C3 in renal tissue and clinical manifestation and prognosis in patients with diabetic nephropathy (DN). Methods: from 2003 to 2013, a total of 460 patients with DN were diagnosed by renal biopsy in Nanjing General Hospital of Nanjing military region. The relationship between the deposition of IgG and C3 in renal tissue and prognosis was observed. Results: (1) according to the deposition of IgG, they were divided into IgG () and IgG (-) groups. The duration of diabetes mellitus was longer, the urine protein was higher, the mean arterial pressure, serum creatinine, glycosylated hemoglobin were higher in group IgG (鈪，

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