Papers
YANG Shan-zhi, ZHANG Ying, QUAN Song-xia, HU Rui-min, YANG Yang, YANG Yu-meng, XING Guo-lan
Objective To analyze the levels of components in complement system, in plasma and urine of diabetic kidney disease (DKD) patients, and their correlation with clinical, pathological features and prognosis. Methods The plasma and urine samples of 50 biopsy-diagnosed DKD patients (DKD group) and 50 cases of diabetic patients without no renal injury (DM group) and 50 cases of normal control groups were collected. Five complement components (factor H, factor B, factor P, C1q and C5a) were measured by enzyme-linked immunosorbent assay (ELISA).COX proportional hazard regression model was used to analyze the independent risk factors affecting renal prognosis, and ROC curve was drawn to analyze the value of factor B and C5a in predicting renal prognosis. Results In DKD patients, plasma levels of complement factor B, factor P, C1q and C5a were significantly higher than those in DM group and normal control subjects (P<0.05),factor H was lower than the healthy control group (P=0.03) and the DM group (P<0.001).Urine complement factor B, P factor and C5a were significantly higher than the healthy control group and the DM group (P<0.05), and factor H was lower than the healthy control group (P<0.001) and the DM group (P=0.008). There was no significant difference in the level of urinary C1q among the three groups. The levels of factor H, factor B, factor P and C5a were related to proteinuria, renal function and pathological changes of renal tissue. Multivariate Cox analysis showed that both urinary complement factor B (HR=2.63, 95% CI:1.377-5.023, P<0.001) and C5a (HR=1.33, 95%CI:1.06-1.668,P=0.014) were independent risk factors for renal prognosis. Conclusion In DKD patients, the alternative complement pathway is activated to varying degrees and is associated with proteinuria, renal histopathological changes, and poor renal prognosis. There was no significant correlation between the levels of classical complement pathway initiation factor C1q and the occurrence, development and prognosis of DKD.