National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Front Immunol. 2022 Jul 8;13:929155. doi: 10.3389/fimmu.2022.929155. eCollection 2022.
IgG and complement 3 (C3) are generally found to be deposited along the glomerular basement membrane (GBM) in human anti-GBM disease. The pathogenic role of complement activation in kidney damage of anti-GBM disease has been explored in recent years. Therefore, we investigated the relationship between serum C3 and outcomes among patients with anti-GBM disease in this study.
Ninety-four anti-GBM disease patients between January 2004 and December 2020 at the National Clinical Research Center of Kidney Diseases Jinling Hospital were retrospectively analyzed, and were divided into the low C3 group and the normal C3 group according to serum C3 levels at diagnosis. Fifty-six patients had undergone renal biopsy. We analyzed the clinical manifestations, laboratory tests, kidney pathology, treatment, and outcomes between the two groups. The primary endpoint was kidney failure. Cox regression and smooth curve fitting of generalized additive mixed model analysis were used to explore the correlation between serum C3 and kidney failure. The outcomes of the two groups were compared by the Kaplan-Meier curve.
A total of 94 patients (aged 43.6 ± 16.2; male patients, 46%) with anti-GBM disease were enrolled. There were 26 patients with low C3 levels and 68 patients with normal C3 levels. Compared with the normal C3 group, patients in the low C3 group have a higher proportion of glomerular sclerosis progressing to kidney failure. Multivariate Cox regression analysis suggested that C3 is associated with kidney outcomes in patients with anti-GBM disease (HR = 0.782, 95% CI = 0.673-0.907, = 0.001). Smooth curve fitting of generalized additive mixed model analysis indicated that the level of C3 had a linear relationship with the changing trend of kidney failure. The Kaplan-Meier curve showed that there was a statistical difference between the two groups in terms of kidney failure ( = 0.033).
The kidney outcomes of anti-GBM disease in the low C3 group were poorer than those in the normal C3 group. The influence of C3 on the kidney outcomes of patients with anti-GBM disease may be of clinical relevance.
在人类抗肾小球基底膜（GBM）疾病中，通常发现 IgG 和补体 3（C3）沿肾小球基底膜（GBM）沉积。近年来，人们探讨了补体激活在抗 GBM 疾病肾损伤中的致病作用。因此，我们在本研究中调查了血清 C3 与抗 GBM 疾病患者结局之间的关系。
回顾性分析 2004 年 1 月至 2020 年 12 月在国家肾脏疾病临床医学研究中心南京总医院接受治疗的 94 例抗 GBM 疾病患者，根据诊断时的血清 C3 水平将患者分为低 C3 组和正常 C3 组。56 例患者进行了肾活检。分析两组患者的临床表现、实验室检查、肾脏病理、治疗和结局。主要终点为肾衰竭。采用 Cox 回归和广义加性混合模型分析的平滑曲线拟合来探讨血清 C3 与肾衰竭之间的相关性。通过 Kaplan-Meier 曲线比较两组患者的结局。
共纳入 94 例（年龄 43.6±16.2；男性患者占 46%）抗 GBM 疾病患者。其中低 C3 组 26 例，正常 C3 组 68 例。与正常 C3 组相比，低 C3 组患者肾小球硬化进展为肾衰竭的比例更高。多变量 Cox 回归分析提示，C3 与抗 GBM 疾病患者的肾脏结局相关（HR=0.782，95%CI=0.673-0.907， =0.001）。广义加性混合模型分析的平滑曲线拟合表明，C3 水平与肾衰竭的变化趋势呈线性关系。Kaplan-Meier 曲线显示，两组患者在肾衰竭方面存在统计学差异（ =0.033）。
低 C3 组抗 GBM 疾病患者的肾脏结局较差。C3 对抗 GBM 疾病患者肾脏结局的影响可能具有临床相关性。
