补体、NPAR与特发性膜性肾病及脾肾阳虚证的相关性研究OA

Objective To explore the correlation between complement,neutrophil percentage-to-albumin ratio(NPAR)and spleen-kidney yang deficiency syndrome,renal pathology and biochemical indexes in idiopathic membranous nephropathy(IMN).Methods Clinical data of 73 IMN patients diagnosed by renal biopsy at Dongcheng Campus of Dongzhimen Hospital,Beijing University of Chinese Medicine from January 1,2014 to June 30,2024 were retrospectively collected.According to the deposition intensity of complement C3 in renal tissue(immunofluorescence results),the patients were divided into four groups:"-group"(14 cases),"1+group"(38 cases),"2+group"(18 cases)and"3+group"(3 cases).According to TCM diagnostic criteria,they were divided into spleen-kidney yang deficiency syndrome group(29 cases)and non-spleen-kidney yang deficiency syndrome group(44 cases).The clinical data and pathological characteristics of different renal complement C3 deposition intensities were compared.The correlations between complement C3 deposition,serum complement,NPAR and biochemical indexes were analyzed.The differences in renal complement C3 deposition intensity,biochemical indexes and NPAR between spleen-kidney yang deficiency syndrome group and non-spleen-kidney yang deficiency syndrome group were compared,and the diagnostic value of NPAR for spleen-kidney yang deficiency syndrome in IMN was analyzed.Results(1)In terms of biochemical indexes and pathological characteristics with different renal complement C3 deposition intensities:there were statistically significant differences in serum uric acid(UA),24hUTP,total cholesterol(CHOL),low-density lipoprotein cholesterol(LDL-C),total protein,albumin and NPAR among the four groups of IMN patients with different renal complement C3 deposition intensities,the difference being statistically significant(P＜0.05 or P＜0.01).There were also statistically significant differences in renal interstitial fibrosis and tubular atrophy among the four groups(P＜0.05).(2)Correlation analysis showed that renal complement C3 deposition in IMN was positively correlated with NPAR,24hUTP,CHOL and LDL-C(r=0.334,0.268,0.375,0.451,P＜0.05),and negatively correlated with UA,total protein and albumin(r=-0.275,-0.375,-0.388,P＜0.05).Serum complement C3 was positively correlated with triglyceride(TG)(r=0.266,P＜0.05)and negatively correlated with high-density lipoprotein cholesterol(HDL-C)(r=-0.255,P＜0.05).Serum complement C4 was positively correlated with NPAR,24hUTP,TG and LDL-C(r=0.240,0.257,0.403,0.254,P＜0.05).NPAR was positively correlated with 24hUTP,CHOL and LDL-C(r=0.538,0.577,0.603,P＜0.05)and negatively correlated with UA,total protein and albumin(r=-0.265,-0.797,-0.887,P＜0.05).(3)In terms of renal complement C3 deposition intensity,NPAR and clinical parameters between spleen-kidney yang deficiency syndrome group and non-spleen-kidney yang deficiency syndrome group:the renal complement C3 deposition intensity,NPAR,24hUTP,CHOL and LDL-C levels in the spleen-kidney yang deficiency syndrome group were higher than those in the non-spleen-kidney yang deficiency syndrome group,while the total protein and albumin levels were lower than those in the non-spleen-kidney yang deficiency syndrome group,with statistically significant differences(P＜0.05 or P＜0.01).(4)In terms of the diagnostic value of NPAR for spleen-kidney yang deficiency syndrome in IMN:receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of NPAR for diagnosing spleen-kidney yang deficiency syndrome in IMN was 0.705(95%CI:0.586-0.824),with a cut-off value of 25.18,and the difference was statistically significant(P＜0.05).Conclusion Extensive deposition of renal complement C3,high serum complement C4 level and high NPAR value are all associated with more severe IMN at renal biopsy,and their levels can provide reference for clinical disease assessment.Patients with spleen-kidney yang deficiency syndrome of IMN have more severe disease conditions,which is correlated with renal complement C3 deposition intensity.NPAR has certain diagnostic value for spleen-kidney yang deficiency syndrome and is expected to become a risk predictor and inflammatory marker for IMN.