标题：不同牛津病理分型 IgA肾病患者炎症指标、IgA及 IgA/C3水平的变化及其临床意义

      作者：杨天开，曾蕾，罗远标，黄少珍，宋冬芳，钟丽    湛江中心人民医院肾内科，广东 湛江 524000

      卷次： 2020年31卷14期

      【摘要】 目的 检测不同牛津病理分型 IgA肾病患者的炎症指标、IgA及 IgA/补体3 (C3)水平，并探讨其临床意义。方法 选择2016年6月至2019年5月于湛江中心人民医院肾内科就诊的60例 IgA肾病患者(IgA肾病组)为研究对象，参考牛津病理分型将所有患者分为轻度组36例和重度组24例。另选择非 IgA肾病原发性肾小球肾炎患者40例作为对照组。检测所有患者的白细胞介素-6 (IL-6)、肿瘤坏死因子-α (TNF-α)、转化生长因子-β1 (TGF-β1)、IgA及 IgA/C3水平，分析 IgA、IgA/C3对不同牛津病理分型的诊断灵敏度和特异度。结果 IgA肾病组患者的 IgA、IgA/C3水平分别为(2.95±0.78) g/L、3.07±1.02，明显高于对照组的(2.24±0.62) g/L、2.35±0.74，差异均有统计学意义(P<0.05)，而两组患者的C3水平比较差异无统计学意义(P>0.05)；轻度组患者的 IgA、IgA/C3水平分别为(2.68±0.63) g/L、2.69±0.75，明显低于重度组的(3.09±0.77) g/L、3.31±1.02，差异均有统计学意义(P<0.05)。而两组患者的C3水平比较差异无统计学意义(P>0.05)；轻度组和重度组患者 IL-6 [(106.28±25.25) ng/L vs (142.18±29.61) ng/L]、TNF-α [(119.76±28.37) ng/L vs (47.42±32.15) ng/L]、TGF-β1 [(19.84±5.59) μg/L vs (33.47±7.86) μg/L)]水平比较，轻度组明显低于重度组，差异均有统计学意义(P<0.05)；IgA和 IgA/C3区分 IgA肾病患者轻度与重度病理改变的灵敏度分别为53.07%、64.05%，特异度分别为75.12%、68.09%，提示鉴别轻度和重度 IgA肾病的准确性较差。结论 IgA肾病患者的牛津病理分型各个病理指标表现越明显，炎症指标、IgA及 IgA/C3水平越高，但 IgA及 IgA/C3对鉴别IgA肾病轻度和重病理改变的灵敏度和特异度较差，仅可作辅助指标应用。
      【关键词】 IgA肾病；牛津病理分型；炎症指标；IgA；IgA/C3；临床意义
      【中图分类号】 R692 【文献标识码】 A 【文章编号】 1003—6350（2020）14—1787—03

Changes of inflammatory indexes, IgA, and IgA/C3 levels in patients with IgA nephropathy of different Oxfordpathological types and their clinical significance.
YANG Tian-kai, ZENG Lei, LUO Yuan-biao, HUANG Shao-zhen,SONG Dong-fang, ZHONG Li. Department of Renal Medicine, Zhanjiang Central People's Hospital, Zhanjiang 524000,Guangdong, CHINA
【Abstract】 Objective To detect the inflammatory indexes, IgA, and serum immunoglobulin A/complement fac-tor 3 (IgA/C3) levels in patients with IgA nephropathy of different Oxford pathological types and to explore their clinicalsignificance. Methods A total of 60 IgA nephropathy patients (IgA nephropathy group), who were treated in the Depart-ment of Nephrology, Zhanjiang Central People's Hospital from June 2016 to May 2019, were selected as the study ob-jects. All patients were divided into the mild group (n=36) and severe group (n=24) according to Oxford pathologicalclassification. In addition, 40 patients with non-IgA nephropathy primary glomerulonephritis were selected as the controlgroup. The levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), transforming growth factor-β 1 (TGF-β 1),IgA and IgA/C3 were measured in all patients, and the diagnostic sensitivity and specificity of IgA and IgA/C3 to differ-ent Oxford pathological types were analyzed. Results The levels of IgA and IgA/C3 in IgA nephropathy group were(2.95±0.78) g/L and 3.07±1.02, which were significantly higher than corresponding (2.24±0.62) g/L and 2.35±0.74 in thecontrol group (P<0.05), but there was no significant difference in C3 level between the two groups (P>0.05); IgA andIgA/C3 levels in the mild group were (2.68±0.63) g/L, 2.69±0.75, respectively, which were significantly lower than cor-responding (3.09±0.77) g/L and 3.31±1.02 in the severe group (P<0.05); there was no significant difference between thetwo groups in C3 level (P>0.05); the levels of IL-6, TNF-α, TGF-β 1 in the mild group were (106.28 ± 25.25) ng/L,(119.76 ± 28.37) ng/L, (19.84 ± 5.59) μ g/L, respectively, which were significantly lower than corresponding (142.18 ±29.61) ng/L, (47.42±32.15) ng/L, (33.47±7.86) μg/L in severe group (all P<0.05); the sensitivity of IgA and IgA/C3 were53.07% and 64.05% and the specificity were 75.12% and 68.09%, indicating that the accuracy was poor in distinguish-ing mild from severe IgA nephropathy. Conclusion The more obvious the Oxford pathological classification of IgA ne-phropathy is, the higher the level of inflammation index, IgA and IgA / C3 is. However, the sensitivity and specificity ofIgA and IgA/C3 to distinguish mild and severe pathological changes of IgA nephropathy are poor, which can only beused as auxiliary indexes.
      【Key words】 IgA nephropathy; Oxford pathological types; Inflammation index; IgA; Immunoglobulin A/comple-ment factor 3 (IgA/C3); Clinical significance