Analysis Of Prognosis And Related Risk Factors In Patients With ANCA Associated Vasculitis With C3 Level Reduction

Objective: To investigate the relationship between serum C3 and the clinical manifestations,serological characteristics,treatment and clinical efficacy of renal damage in ANCA associated vasculitis(AAV)patients.Methods: Selected the Clinical data of 304 patients with AAV diagnosed in the first affiliated hospital of Xinjiang medical university from January 2010 to January 2018,and a total of 200 patients were selected.According to limit of sC3 normal range,the subjects were divided into low C3 group(sC3<0.79g/L,n=85)and Normal C3 group(sC3≥0.79g/L,n=115).The patients were compared in Clinical characteristics,laboratory data,therapy and clinical effects.200 patients were divided into endpoint Event Group(n=75)and non-endpoint Event Group(n=125),compared with two groups of patients ’ laboratory indexes,and the influencing factors of AAV patients ’ endpoint events were analyzed by multi-factor logistic regression.Results: Date showed,The serum creatinine value,24-hour urine protein quantification and Birmingham vasculitis activity score(BVAS)in the low C3 group were higher than those in the normal C3 group(P<0.05);Hemoglobin,platelet count,eGFR value,complement C4,c-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)in the low C3 group were all lower than those in the normal C3 group(P<0.05);There was no significant difference between the two groups in age,gender,ANCA type、ANCA titer,white blood cell and albumin level(P > 0.05);There were statistically significant differences in renal manifestations between the two groups(P<0.05);There were no statistically significant differences between the two groups in non-specific clinical manifestations,hypertension,incidence of hematuria,respiratory system,cardiovascular system,nervous system,skin,ear,nose,throat and digestive system(P>0.05);In the comparison of treatment schemes,the utilization rate of intensive treatment 、renal replacement therapy、plasma pheresis in the low C3 group was higher than that in the normal C3 group(P<0.05),and there was no significant difference between the two groups in the utilization rate of conventional treatment and steroids only(P>0.05);Kaplan-Meier survival curve showed that the survival rate of patients in the low C3 group was lower than that in the normal C3 group(log-rank=17.734,P<0.05);The age,24 hours urinary protein quantification and serum creatinine level of the patients in the terminal group were higher than that of the non-endpoint group(p<0.05),and the ANCA types and gender of the two groups were statistically significant(p<0.05),the hemoglobin level,the number of platelets,the complement C3 level of the end group were lower than those in the non-endpoint group(p<0.05).Cox regression analysis showed that increased age and blood creatinine levels and 24-hour urine protein was the independent risk factor of prognosis in patients with AAV(P<0.05).Conclusion : Patients with low C3 complement in AAV have more severe renal involvement and mortality than those with normal complement C3,suggesting that complement C3 is of great significance in the pathogenesis of AAV kidney damage,the development of treatment plan and the determination of prognosis,should be attached importance.