BACKGROUND:Aberrant activation of the complement system plays an important role in the pathogenesis and development of immunoglobulin A nephropathy (IgAN). The relationship between serum complement and the clinical-histopathological features and outcomes of IgAN is controversial. This retrospective study aimed to examine the relationship between the complement 3/4 (C3/C4) ratio and the clinicopathologic changes and prognosis of patients with IgAN. METHODS:A total of 397 patients with primary IgAN from January 2007 to December 2012 at the Chinese People's Liberation Army General Hospital were included in this study. The correlation test and Chi-square test or one-way analysis of variance test were performed to evaluate the relationship between the C3/C4 ratio and other clinical-pathological factors. Propensity score matching and a multivariate Cox regression model were used to calculate the risk factors of renal outcome. RESULTS:The median follow-up period was 75 months. During the follow-up period, 62 patients (15.6%) developed into the end-stage renal disease (ESRD). The C3/C4 ratio at baseline was associated with the level of serum creatinine (SCr), 24 h urinary protein excretion (24 h Upre), global glomerular sclerosis, and tubulointerstitial lesion. The level of SCr and 24 h Upre and the degree of chronic kidney injury were statistically different among groups defined by different C3/C4 ratio levels. The survival rates of patients among groups with different C3/C4 ratio levels were different. After propensity score matching, eighty-eight pairs of patients were successfully matched, and the C3/C4 ratio was an influencing factor for the patients' outcome (hazard ratio 0.587, 95% confidence interval 0.329-0.880). Patients with a C3/C4 ratio <3.6 had a poorer outcome compared with the others (P = 0.002). CONCLUSIONS:IgAN patients with decreased C3/C4 ratio displayed significantly more severe clinical symptoms and chronic renal injury than patients with higher ratios. A low C3/C4 ratio could be a risk factor for patients developing to ESRD.

译文

背景:补体系统的异常激活在免疫球蛋白A肾病(IgAN)的发病和发展中起着重要作用。血清补体与IgAN的临床组织病理学特征和预后之间的关系尚存争议。这项回顾性研究旨在探讨IgAN患者补体3/4(C3 / C4)比率与临床病理变化和预后之间的关系。
方法:纳入2007年1月至2012年12月在中国人民解放军总医院的397例原发性IgAN患者。进行相关检验和卡方检验或方差检验的单向分析,以评估C3 / C4比率与其他临床病理因素之间的关系。倾向得分匹配和多元Cox回归模型用于计算肾脏预后的危险因素。
结果:中位随访期为75个月。在随访期间,有62名患者(15.6%)患上了晚期肾病(ESRD)。基线时的C3 / C4比值与血清肌酐(SCr),24 h尿蛋白排泄(24 h Upre),总体肾小球硬化和肾小管间质病变的水平有关。在不同的C3 / C4比水平所定义的组之间,SCr和24 h Upre的水平以及慢性肾脏损伤的程度在统计学上是不同的。不同C3 / C4比率水平的组之间患者的存活率是不同的。倾向得分匹配后,成功匹配了88对患者,C3 / C4比是影响患者预后的因素(危险比0.587,95%置信区间0.329-0.880)。 C3 / C4比<3.6的患者的预后较其他患者差(P = 0.002)。
结论:C3 / C4比值降低的IgAN患者比高比值的患者表现出更严重的临床症状和慢性肾损伤。 C3 / C4比率低可能是发展为ESRD患者的危险因素。

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