| Objective:In this study analyses the correlation between serum C3,C4,and C3/C4 levels and clinical and pathological features in patients with IgA nephropathy,and explores the relationship between the complement system and IgA nephropathy disease progression.in order to provide certain reference value for the disease monitoring and prognosis evaluation of IgA nephropathy based on complement.Methods:A total of 205 primary IgA nephropathy patients diagnosed by renal biopsy in the Department of Nephrology,the First Affiliated Hospital of Kunming Medical University from October 2019 to October 2022 were selected as research objects.patient data including general information,laboratory data,renal pathology data,and serum C3 and C4 levels were collected,then the C3/C4 ratios were calculated.The study analyzed the correlation between serum C3,C4,C3/C4 and clinical presentation and renal pathological features.All data were statistically analyzed via data analysis software(SPSS 26.0).Results:1.General information: A total of 205 IgA nephropathy patients were included,including 93 males and 112 females.The median age at the time of renal biopsy was 34(27,42)years,and the median course of disease was 10(2,36)months.Patients with hypertension accounted for 33.17%,and patients with stage CKD1 accounted for 33.66%.The composition ratios of Class Ⅰ,Ⅱ,Ⅲ,Ⅳ and Ⅴ of Lee’s classification were 0,15.12%,56.1%,19.02% and 9.76%,respectively.The detection rates of M1,E1,S1,T1+T2 and C1+C2 were 97.07%,31.22%,60.49%,24.88% and47.32%,respectively.Serum C3 levels decreased in 5 cases(2%)and serum C4 levels increased in 5 cases(2%).2.Clinical features:(1)Serum C3 level was positively correlated with age,BMI,white blood cell,red blood cell,hemoglobin,platelet,immune inflammatory index,albumin,total cholesterol,triglyceride,serum IgG and serum IgA(P<0.05),but negatively correlated with urea and high-density lipoprotein cholesterol(P<0.05).Serum C4 level was positively correlated with age and serum creatinine(P<0.05),but negatively correlated with lymphocyte(P<0.05).Serum C3/C4 level was positively correlated with lymphocyte(P<0.05),but negatively correlated with age,urea,serum creatinine and uric acid(P<0.05).(2)Different levels of serum C4,C3/C4 in different degrees of albuminuria,with the increase of albuminuria,serum C4 level increased,serum C3/C4 level decreased.(P<0.05).(3)The levels of serum C3,C4 and C3/C4 were different in different CKD stages.With the decrease of glomerular filtration rate,the levels of serum C3 and C3/C4 were decreased and the level of serum C4 was increased(P<0.05).3.Pathological features:(1)Serum levels of C4 and C3/C4 were different in different Lee grades,The higher the Lee grade of renal pathology,the higher the serum C4 level and the lower the C3/C4 level(P<0.05).(2)Serum C4 and C3/C4 levels were different only in T0 group and T1+T2 group in different Oxford pathological classification(MEST-C)groups.The more severe renal tubular atrophy/interstitial fibrosis(T),the higher the serum C4 level and the lower the C3/C4level(P<0.05).There were no significant differences in serum C3,C4 and C3/C4 levels among mesangial hypercellularity(M),endocapillary hypercellularity(E),segmental glomerulosclerosis(S),cellular or fibrocellular crescents(C)(P>0.05).4.Multiple Logistic regression analysis showed that age,hemoglobin,uric acid and urea were independent risk factors for renal function progression in IgA nephropathy patients(P<0.05).Conclusions:1.In patients with primary IgA nephropathy,decreased serum C3 levels,elevated C4 levels,and decreased C3/C4 levels are indicative of more severe clinical and pathological damage and poor prognosis.2.In clinical work,the serum levels of C3,C4 and C3/C4 can be dynamically monitored,to early identification of high-risk patients with IgA nephropathy disease progression,and improvement of the survival rate of patients.3.Age,hemoglobin,uric acid and urea were independent risk factors for renal function progression in IgA nephropathy patients. |
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