Combination of anti-C1q and anti-dsDNA antibodies is associated with higher renal disease activity and predicts renal prognosis of patients with lupus nephritis
Combination of anti-C1q and anti-dsDNA antibodies is associated with higher renal disease activity and predicts renal prognosis of patients with lupus nephritis
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抗 C1q 和抗 dsDNA 抗体的组合与较高的肾脏疾病活动度相关，并可预测狼疮性肾炎患者的肾脏预后
DOI：
10.1093/ndt/gfs179
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发表时间：
2012-09-01
影响因子：
6.1
通讯作者：
Zhao, Ming-hui
中科院分区：
文献类型：
--
作者：
Yang, Xiao-wei;Tan, Ying;Zhao, Ming-hui
尽管肾源性自身抗体被认为在狼疮性肾炎的发生中起着核心作用，但这些自身抗体是否与肾脏临床和病理活动或肾脏结局有关仍存在争议。在此，我们研究了中国狼疮性肾炎患者中某些血清自身抗体与肾脏疾病活动性和肾脏预后的关系。对136例经活检证实的狼疮性肾炎患者进行了长期随访研究。肾活检血清检测一组自身抗体，包括抗核抗体、抗双链DNA（抗dsdna）抗体、抗可提取核抗原抗体、抗c -反应蛋白抗体、抗c1q抗体、抗心磷脂抗体和抗2-糖蛋白I抗体。进一步研究了这些自身抗体与临床特征、实验室结果、组织病理学数据和肾脏预后的关系。在各种自身抗体中，抗dsdna和抗c1q抗体较其他抗体更好地评价肾脏疾病活动性。抗dsdna抗体与白细胞尿发生率增高（p0.05）、总病理活动指数（AI）评分增高（p0.05）、毛细血管内细胞增多（p0.05）、内皮下透明质沉积（p0.05）和白细胞浸润（p0.05）相关。抗c1q抗体与白细胞尿（p0.01）、血尿（p0.003）和大部分组织病理学AIs相关，包括AI总评分（p0.003）、毛细血管内细胞增多（p0.003）、细胞新月形（p0.05）、核裂/纤维蛋白样坏死（p0.003）、内皮下透明质沉积（p0.003）和白细胞浸润（p0.01）。与没有这两种抗体的患者相比，同时具有抗dsdna和抗c1q抗体的患者有更高的肾脏疾病活动性和更差的肾脏预后（log-rank检验：P 0.048）。在肾脏预后的单因素生存分析中，抗c1q和抗dsdna抗体的存在都不是肾脏生存的危险因素。然而，两种抗体联合使用预测肾脏预后（危险比4.40,95可信区间：1.26815.269,P 0.02）。与其他自身抗体相比，抗c1q抗体与肾脏疾病活动性的关系更为密切。抗c1q和抗dsdna自身抗体联合表明肾脏疾病活动性较高，并预测肾脏预后不良。
Although nephritogenic autoantibodies are considered to play a central role in the initiation of lupus nephritis, whether these autoantibodies are associated with renal clinical and pathological activity or renal outcome is still controversial. Here, we investigated the associations of certain serum autoantibodies with renal disease activity and renal outcome in a large cohort of Chinese patients with lupus nephritis.One hundred and thirty-six Chinese patients with biopsy-proven lupus nephritis and with long-term follow up data were studied. Sera at renal biopsy were tested for a panel of autoantibodies, including anti-nuclear antibodies, anti-double-stranded DNA (anti-dsDNA) antibodies, anti-extractable nuclear antigen antibodies, anti-C-reactive protein antibodies, anti-C1q antibodies, anti-cardiolipin antibodies and anti-2-glycoprotein I antibodies. Associations of these autoantibodies with clinical features, laboratory findings, histopathological data and renal outcomes were further investigated.Among the various autoantibodies, anti-dsDNA and anti-C1q antibodies were better than other antibodies to evaluate the renal disease activity. Anti-dsDNA antibodies were correlated with higher incidence of leukocyturia (P 0.05), total pathological activity index (AI) score (P 0.05), endocapillary hypercellularity (P 0.05), subendothelial hyaline deposits (P 0.05) and leukocyte infiltration (P 0.05). Anti-C1q antibodies were correlated with leukocyturia (P 0.01), hematuria (P 0.003) and the majority of the histopathological AIs including total AI score (P 0.003), endocapillary hypercellularity (P 0.003), cellular crescents (P 0.05), karyorrhexis/fibrinoid necrosis (P 0.003), subendothelial hyaline deposits (P 0.003) and leukocyte infiltration (P 0.01). Patients with both anti-dsDNA and anti-C1q antibodies had higher renal disease activity and poorer renal outcome (log-rank test: P 0.048) compared with those without the two antibodies. In univariate survival analysis of renal prognosis, neither the presence of anti-C1q nor the presence of anti-dsDNA antibodies was a risk factor of renal survival. However, the combination of the two antibodies predicted renal prognosis (hazard ratio 4.40, 95 confidence interval: 1.26815.269, P 0.02).Anti-C1q antibodies are more closely correlated with renal disease activity than the other autoantibodies. The combination of anti-C1q and anti-dsDNA autoantibodies indicates higher renal disease activity and predicts poor renal outcome.