A Comparative Study Of Immunoglobulin And Complement Levels And Immunopathology In Patients With Primary Glomerular Diseases

Objective: The objective of this study was to investigate the relationship between the pathological fluorescence immune intensity of kidney and serum immunoglobulin and complement values in patients with immunoglobulin A nephropathy(Ig AN)and membranous nephropathy(MN),as well as the correlation between the two groups,and to screen and study the effective indicators with diagnostic value,so as to provide scientific basis of an assistant diagnosis for the two types of primary glomerular diseases.Method: 1.Subjectives: A total of 332 patients with Ig AN and MN diagnosed by renal biopsy in our hospital from January 2017 to December 2018 were included.The patients were divided into two groups according to their pathological types: 85 in Ig AN group and 247 in MN group.2.General information recording inductees,including gender,age,duration of dialysis,primary disease,whether the recent infection,with or without consolidation diabetes.2.Record the general information of the participants(gender,age,etc.).3.Laboratory indicators: serum Ig A,serum Ig G,serum Ig M,serum C3,serum C4,serum creatinine,blood urea nitrogen and other indicators were measured in the Laboratory Department of our hospital.4.Criteria for judging pathological intensity: Classification of renal pathological immune complex intensity: negative(-),weak positive(++): and strong positive(+++).The intensity of immune complex was determined by the fluorescence intensity: no negative fluorescence(-)was observed in the idney tissues under low magnification and high magnification;visible under low magnification,visible under high magnification,defined as weak positive(+);visible under low magnification,visible under high magnification,defined as positive(++);visible under low magnification,visible under high magnification,visible under high magnification and dazzling under high magnification.Strong positive(+++)was defined.5.Statistical methods: SPSS statistical software(version 19.0)was used for statistical analysis.The measurement data of normal distribution are described in the form of mean(+standard deviation),and the comparison between the two groups is t-test;the measurement data of non-normal distribution are described in the form of median M(P25,P75),and the comparison between the two groups is conducted in the form of Mann-Whitney U test;the comparison between the two groups is conducted in the form of 2 test;the trend is analyzed by correlation analysis,and rank sum test is used for orderly multi-group and multi-classification data.Bivariate Logistic analysis was used for multivariate analysis.Results: Significant findings of this study are shown as follows: 1.A total of 332 subjects were included in this study,including 85 in Ig AN group and 247 in MN group,199 males and 133 females.The oldest is 84-year old and the youngest is 17-year old.2.Comparisons of various indicators between the two groups:(1)Comparing the C3 IF pathological intensity between the two groups,the intensity of complement C3 in Ig AN group was stronger than that in MN group(P=0.002);the intensity of Ig G in Ig AN group was weaker than that in MN group(P<0.001);(2)Compared with the indicators of serum immune complexes and complements,the values of s Ig A and s Ig G in Ig AN group were higher than those in MN group(P<0.001,P<0.001).The values of s C3 and s C4 in Ig AN group were lower than those in MN group(P=0.008,P=0.001);(3)The levels of BUN and SCR in Ig AN group were higher than those in MN group(P<0.001,P=0.016).3.Correlation of various indicators within each groups:(1)Serum indicators were correlated with C3 pathological intensity grade;e.g.s C3 and s C4 level in Ig AN group were negatively correlated with C3 pathological intensity grade(P=0.01,P=0.02);s C3 level in MN group was negatively correlated with C3 pathological intensity grade(P=0.02);and(2)Serum indicators were correlated with Ig G pathological intensity grade;e.g.Scr and s Ig A level in Ig AN group were negatively correlated with C3 pathological intensity grade.The level of s Ig G was negatively correlated with Ig G pathological intensity grade(P=0.01,P=0.01);the level of s Ig G was negatively correlated with Ig G pathological intensity grade(P=0.01)in MN group;(3)The comparison of renal function indicators among different pathological intensity grades: Scr and BUN were different in Ig G pathological grade in all samples(P<0.001,P=0.002),and Scr was different among different C3 pathological intensity grades.The difference was statistically significant(P=0.03).(4)The deposition of Ig A and C3 in kidney tissue was correlated with serum Ig A and C3(P < 0.15,P < 0.15).Conclusion: Some serum indicators,especially serum C3 level,are highly negatively correlated with C3 IF pathological intensity.In MN group,s Ig G level was negatively correlated with Ig G intensity grade.For Ig AN patients,the decrease of C4 level can also reflect the increase of C3 IF pathological intensity.It is suggested that serum C3 and C4 may be used as a basis for assistant diagnosis of glomerular diseases in clinical practice.