Study On The Relationship Between Serum Complement C3,C4,C3/C4 And The Clinic,Pathology And Prognosis Of Primary Adult IgAN

Objective:Immunoglobulin nephropathy A(Ig AN)is currently one of the most common primary glomerular diseases worldwide,and the ultimate goal of delaying progression to End stage renal disease(ESRD).This article analyzes the pre-treatment and post-treatment status of patients with Ig AN and discuss the relationship between complement C3,C4 and the ratio of C3 to C4 and the clinic,pathology,and prognosis of patients with Ig AN.What’s more,we compare the differences between complement C3,C4 and the ratio of C3 to C4 when judging the prognosis,thus providing assistance for early detection of intervention in patients with Ig AN to benefit from longer survival.Method:1 Subjects:A total of 135 patients with primary Ig A nephropathy who were admitted to the department of nephropathy of our hospital from January1,2015 to May 31,2019 and confirmed by renal biopsy were collected.2 Clinical observational measures were as follows: Sex,Age,Body mass index(BMI),Hypertension grade and the count;Diastolic blood pressure(DBP),Systolic blood pressure,(SBP),Triglyceride(TG),Cholesterol(TC),Blood urea nitrogen(BUN),Serum creatinine(Scr),Uric acid(UA),24 h urine protein quantification(24h-UP),Albumin(Alb),Estimated glomerular filtration rate(e GFR),Complement C3,C4,and the ratio of complement C3 to complement C4.3 Collect pathological indicators: count the number of cases of patients at all levels of oxford pathology grade.4 Prognostic indicators were collected:24-hour urine protein and creatinine obtained from follow-up and the glomerular filtration rate wascalculated.(Statistics at the end of 1st,3rd and 6th months after kidney puncture.)5 Statistical method: All data were analyzed by SPSS 25.0 statistical software.The measured data are indicated by mean ± standard deviation(x±s)if they conform to normal distribution.They are indicated by median(quartile)[ P50(P25,P75)] if they conform to non-normal distribution.If it is a counting data,it is expressed as a percentage.Multiple sample mean comparisons were performed using univariate ANOVA.Correlation analysis using Spearman correlation analysis.Multiple linear regression to explore the influencing factors of e GFR.ROC curve calculates the area under the curve and evaluates the prognostic ability.Binary logistic regression to investigate the independent risk factors which can affect outcomes in patients with Ig AN.When P<0.05,the difference was statistically significant.Results:1 General information on selected personsA total of 135 patients were included,of which 54.07% were male(73)and 45.93% were female(62).The average age at renal biopsy was 41(29,53)years,ranging from 18 to 69 years.36.30% of patients have hypertension.Patients with normal renal function(CKD stage1)accounted for48.15%.The composition ratios of M0,E0,S0 and T0 are54.81%,80.00%,74.81%,64.45%.2 Comparison of serum complement levels of C3,C4 and C.ratio in adult patients with different characteristics with primary Ig A nephropathy.2.1 Serum complement C3,C4 levels and C.ratio in patients with different CKD stages.The serum level of complement C3 and C.ratio.were different in different CKD stages,and the difference was statistically significant(P< 0.05).2.2 Serum complement C3,C4 levels and C.ratio of patients with different hypertension grades.The serum level of complement C4 and C.ratio.were different in different hypertension grades,and the difference was statistically significant(P< 0.05).2.3 Serumcomplement C3,C4 levels and C.ratio in different oxford pathology T grade patients.The serum level of complement C4 and C.ratio.were different in different Tgrades,and the difference was statistically significant(P< 0.05).3 Correlation analysis of complement C3,C4 and C.ratio with clinical and pathological dataC.ratio was positively correlated with e GFR,Alb,DBP(r=0.305,0.305,0.343;P<0.001,P<0.001,P <0.001).C.ratio was negatively correlated with Age,SBP,Scr,UA,24h-UP,BUN T grade、Hpertention grade、CKD stage(-0.205、-0.231、-0.132、-0.183、-0.276、-0.301、-0.229、-0.264、-0.248,P=0.017、0.007、P<0.001、0.034、0.001、P<0.001、0.007、0.002、0.004);Serum complement C4 was positively with Scr、CKD stage(r=0.209,P=0.015;r=0.190,P=0.027),Serum C4 was negatively correlated with e GFR(r=-0.217,P =0.012).Serum complement C3 was positively correlated with Alb(r=-0.215,P =0.012).The difference was statistically significant(P<0.05).4 Multiple linear regression analysis of e GFR during renal puncture.Age and the effect of Scr on e GFR was negatively correlated;The effect of C.ratio on e GFR was positively correlated.The regression linear equation is e GFR=128.351-0.375Scr-0.591Age+5.558 C.ratio.5 ROC curves of prognosis of serum complement C3,C4 and C.ratioThe area under the ROC curve was 0.605,95% CI(0.509,0.701).6 Binary logistic regression to explore independent risk factors affecting prognosis of Ig AN patientsT grade of oxford pathological grade and 24h-UP are independent risk factors for the prognosis of Ig AN patients.The difference was statistically significant(P<0.05).Conclusion:1 In patients with Ig AN nephropathy,the lower the serum complementC3/C4,the lower the serum complement C3,and the higher the serum complement C4,the more serious clinical manifestations and pathological damage of the patients,and the correlation of C3/C4 is stronger.2 Serum complement C3/C4 can be used to diagnose prognosis,and the prognosis can be determined by monitoring C3/C4.3 C.ratio can assess the prognosis of Ig AN patients and may be an independent predictor of the prognosis of Ig AN patients.