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目的探讨补体C3沉积对结节性硬化糖尿病肾病患者预后的影响。方法选取2006年1月至2009年12月于郑州大学第一附属医院肾内科住院治疗,经肾穿刺活检证实为结节性硬化糖尿病肾病,并接受血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)类药物治疗的89例患者为研究对象,搜集其临床和病理资料,并完成为期2年的随访,终点事件为肾功能受损(eGFR<45 mL/min)。依据肾脏补体C3沉积的情况,分为C3阳性组和C3阴性组,分别比较两组患者的临床资料及随访过程中肾功能的变化,并采用Kaplan-Meier方法判断C3沉积对结节性硬化糖尿病患者预后的影响。结果 89例研究对象中,免疫荧光显示补体C3阳性的例数为35例,阳性率为39.32%,C3阳性组患者的24 h尿蛋白定量要高于C3阴性组(4.5±2.0对3.4±1.6,P=0.039),在随访过程中C3阳性组患者血清肌酐均值变化显著高于C3阴性组患者(42.4±9.19对28.4±6.38,P<0.001),同时,C3阳性组患者eGFR均值的变化也高于C3阴性组患者(11.4±3.8对9.7±3.2,P<0.05);24个月时两组患者累计生存率差异无统计学意义(Log Rank,P=0.052),进一步延长随访时间至36个月,C3阳性组患者肾功能未达终点的累计生存率显著低于C3阴性组患者(Log Rank,P=0.038)。结论补体C3沉积对结节性硬化糖尿病肾病远期预后存在一定程度的影响。
Objective To investigate the effect of complement C3 deposition on the prognosis of patients with tuberous sclerosis and diabetic nephropathy. Methods From January 2006 to December 2009 in the Department of Nephrology, First Affiliated Hospital of Zhengzhou University, hospitalized for renal tuberculosis biopsy confirmed as tuberous sclerosis diabetic nephropathy and angiotensin converting enzyme inhibitor (ACEI) or blood vessels Eighty-nine patients treated with ARBs were enrolled in this study. Their clinical and pathological data were collected and followed up for 2 years. The end point was impaired renal function (eGFR <45 mL / min) . According to the status of renal C3 deposition, the patients were divided into C3-positive group and C3-negative group. The clinical data and the changes of renal function were compared between the two groups. Kaplan-Meier method was used to determine the effect of C3 deposition on tuberous sclerosis Impact of patient prognosis. Results The positive rate of complement C3 was 89.3% in 89 subjects. The quantification of 24h urinary protein in C3 positive group was higher than that in C3 negative group (4.5 ± 2.0 vs 3.4 ± 1.6 , P = 0.039). The mean serum creatinine in C3-positive patients during follow-up was significantly higher than that in C3-negative patients (42.4 ± 9.19 vs 28.4 ± 6.38, P <0.001). Meanwhile, the changes of mean eGFR in C3-positive patients (11.4 ± 3.8 vs 9.7 ± 3.2, P <0.05). There was no significant difference in cumulative survival rate between the two groups at 24 months (Log Rank, P = 0.052), and the follow-up time was further prolonged to 36 In months, the cumulative survival of patients with C3-positive disease that did not reach the end of renal function was significantly lower than that of patients with C3-negative disease (Log Rank, P = 0.038). Conclusion The deposition of complement C3 has a certain degree of effect on the long-term prognosis of tuberous sclerosis diabetic nephropathy.