C1q、MBL、C5a与2型糖尿病肾脏病进程及肾小管损伤的相关性

doi:10.11958/20250671

天津医药 ›› 2025, Vol. 53 ›› Issue (6): 603-609.doi: 10.11958/20250671

C1q、MBL、C5a与2型糖尿病肾脏病进程及肾小管损伤的相关性

刘丽(), 侯健, 张巧玲, 杨宏秀, 袁宝军()

开滦总医院检验科（邮编063100）

收稿日期:2025-02-17 修回日期:2025-04-07 出版日期:2025-06-15 发布日期:2025-06-20
通讯作者: ^△E-mail：84889568@qq.com
作者简介:刘丽（1983），女，主任技师，主要从事糖尿病肾病标志物检测方面研究。E-mail：huili-1983@163.com
基金资助:
河北省医学科学研究课题计划资助(20221589)

The correlation between C1q, MBL, C5a and the progression of type 2 diabetes nephropathy and tubular injury

LIU Li(), HOU Jian, ZHANG Qiaoling, YANG Hongxiu, YUAN Baojun()

Department of Clinical Laboratory, Kailuan General Hospital, Tangshan 063100, China

Received:2025-02-17 Revised:2025-04-07 Published:2025-06-15 Online:2025-06-20
Contact: ^△E-mail: 84889568@qq.com

刘丽, 侯健, 张巧玲, 杨宏秀, 袁宝军. C1q、MBL、C5a与2型糖尿病肾脏病进程及肾小管损伤的相关性[J]. 天津医药, 2025, 53(6): 603-609.

LIU Li, HOU Jian, ZHANG Qiaoling, YANG Hongxiu, YUAN Baojun. The correlation between C1q, MBL, C5a and the progression of type 2 diabetes nephropathy and tubular injury[J]. Tianjin Medical Journal, 2025, 53(6): 603-609.

摘要/Abstract

摘要：

目的探讨补体1q（C1q）、甘露糖结合凝集素（MBL）、补体5a（C5a）在糖尿病肾脏病（DKD）早期诊断和病情监测中的临床价值，以及与肾小管损伤的关系。方法选取2型糖尿病患者232例。按尿白蛋白/肌酐比值（UACR）和估算肾小球滤过率（eGFR）将患者分为单纯糖尿病（SDM）组50例和DKD组182例，其中DKD组又分为低进展风险DKD（LDKD）组90例、中进展风险DKD（MDKD）组55例和高进展风险DKD（HDKD）组37例。选取同期体检健康者40例为健康对照组（NC组）。根据N-乙酰-β-D-氨基葡萄糖苷酶/尿肌酐（NAG/Ucr）四分位水平将DKD组按肾小管损伤程度从轻到重分为Q1—Q4组。检测各组一般生化指标及C1q、MBL、C5a水平。Spearman法分析C1q、MBL、C5a与肾小球、肾小管损伤指标的相关性。多因素有序Logistic回归分析DKD进展风险及肾小管损伤程度的影响因素。结果 DKD组收缩压、舒张压、甘油三酯、血肌酐（Scr）、尿酸、UACR、NAG/Ucr、C1q、MBL、C5a水平均高于SDM组和NC组，总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白B（ApoB）、糖化血红蛋白（HbA1c）水平高于NC组，高密度脂蛋白胆固醇（HDL-C）水平低于NC组；SDM组TC、LDL-C、HbA1c、NAG/Ucr水平高于NC组，HDL-C水平低于NC组（P<0.05）。HDKD组C1q水平高于SDM组、LDKD组、MDKD组，MBL和C5a水平高于SDM组、LDKD组；MDKD组MBL、C5a水平高于SDM组、LDKD组；LDKD组MBL水平高于SDM组（P<0.05）。Q4组TC、ApoB、HbA1c、Scr、UACR、C1q、C5a水平高于Q1组，TC、ApoB、Scr、UACR、C1q、C5a水平高于Q2组，UACR、C5a水平高于Q3组；Q3组HbA1c、Scr、UACR、C1q、C5a水平高于Q1组；Q2组UACR水平高于Q1组（P<0.05）。Spearman相关分析显示，C1q、MBL、C5a与UACR、NAG/Ucr呈正相关，与eGFR呈负相关（P<0.05）。有序Logistic回归分析显示，MBL、C5a、NAG/Ucr、Scr、收缩压水平升高是DKD患者进展的危险因素（P<0.05）；C5a、HbA1c、UACR水平升高是DKD患者肾小管损伤的危险因素（P<0.01）。结论 C1q、C5a可用于中晚期DKD及肾小管损伤的监测，且C5a是DKD进展和肾小管损伤的独立危险因素。MBL可用于筛查早期DKD，也是其进展的独立危险因素。

关键词: 糖尿病, 2型, 糖尿病肾病, 补体C1q, 补体激活途径, 甘露糖结合凝集素, 补体C5a, 肾小管

Abstract:

Objective To explore the clinical value of complement 1q (C1q), mannose-binding lectin (MBL) and complement 5a (C5a) in the early diagnosis and disease monitoring of diabetic kidney disease (DKD), as well as their relationship with renal tubular injury. Methods A total of 232 patients with type 2 diabetes mellitus admitted to the Endocrinology Department of Kailuan General Hospital from December 2020 to December 2021 were selected in this study. Patients were divided into the simple diabetes mellitus (SDM) group (n=50) and the DKD group (n=182) based on urinary albumin/creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). The DKD group was further divided into the low-risk diabetic nephropathy (LDKD) group (n=90), the moderate-risk diabetic nephropathy (MDKD) group (n=55) and the high-risk diabetic nephropathy (HDKD) group (n=37) according to the risk of chronic kidney disease progression. Forty healthy individuals who underwent physical examinations in our hospital during the same period were selected as the healthy control group (NC group). The DKD group was divided into the Q1-Q4 groups based on the quartile levels of NAG/Ucr according to the severity of renal tubular injury from mild to severe. General biochemical indicators, as well as the levels of C1q, MBL and C5a in each group were detected. Spearman correlation analysis was used to analyze the correlation between C1q, MBL, C5a and glomerular and tubular injury indexes. Multivariate ordinal Logistic regression analysis was used to analyze the influencing factors of the progression risk of DKD and the degree of renal tubular injury. Results The levels of systolic blood pressure, diastolic blood pressure, triglycerides (TG), serum creatinine (Scr), uric acid (UA), UACR, NAG/Ucr, C1q, MBL and C5a were higher in the DKD group than those in the SDM group and the NC group. The levels of TC, LDL-C, ApoB and HbA1c were higher than those in the NC group, while the level of HDL-C was lower than that in the NC group. The levels of TC, LDL-C, HbA1c and NAG/Ucr were higher in the SDM group than those in the NC group, while the level of HDL-C was lower than that in the NC group (P<0.05). Among different progression risk groups of DKD, the levels of C1q were higher in the HDKD group than those in the SDM group and the LDKD group. The levels of MBL and C5a were higher in the MDKD group than those in the SDM group and the LDKD group, and the level of MBL was higher in the LDKD group than that in the SDM group (P<0.05). After grouping according to the quartile levels of NAG/Ucr, the levels of TC, ApoB, HbA1c, Scr, UACR, C1q and C5a were significantly higher in the Q4 group than those in the Q1 group. The levels of TC, ApoB, Scr, UACR, C1q and C5a were significantly higher than those in the Q2 group, and the levels of UACR and C5a were significantly higher than those in the Q3 group. The levels of HbA1c, Scr, UACR, C1q and C5a were significantly higher in the Q3 group than those in the Q1 group. The level of UACR was higher in the Q2 group than that in the Q1 group (all P<0.05). The Spearman correlation analysis showed that C1q, MBL and C5a were positively correlated with UACR and NAG/Ucr, and negatively correlated with eGFR (all P<0.05). The ordinal Logistic regression analysis showed that elevated levels of MBL, C5a, NAG/Ucr, Scr and systolic blood pressure were independent influencing factors of progression risk in DKD patients. Elevated levels of C5a, HbA1c and UACR were independent influencing factors of renal tubular injury in DKD patients. Conclusion C1q and C5a can be used to monitor middle and late DKD and tubular injury, and C5a is an independent risk factor for DKD progression and tubular injury. MBL can be used to screen for early DKD and is also an independent risk factor for its progression.

Key words: diabetes mellitus, type 2, diabetic nephropathies, complement C1q, complement pathway, mannose-binding lectin, complement C5a, renal tubules

中图分类号:

R587.2

图/表 5

参考文献 27

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组别			n	年龄/岁		性别（男/女）		BMI/（kg/m²）				吸烟史	SBP/mmHg			DBP/mmHg			TG/（mmol/L）			TC/（mmol/L）
NC组	40	56.22±8.27		20/20		24.88（22.85，27.25）				8	121.30±6.35			78.85±3.96			1.18±0.43			3.75±0.71
SDM组			50	58.78±11.53		27/23		25.69（23.09，28.23）				17	125.32±8.32			81.50±6.98			1.73±0.54			5.07±1.33^a
DKD组			182	59.55±11.03		94/88		26.88（23.75，29.45）				47	139.71±10.85^ab			84.00±7.03^ab			2.36±1.11^ab			5.22±1.69^a
F、χ²或H				16.660		0.150		5.635				2.356	82.377^＊＊			10.911^＊＊			7.686^＊＊			15.330^＊＊
组别	HDL-C/（mmol/L）				LDL-C/（mmol/L）				ApoA1/（g/L）	ApoB/（g/L）			HbA1c/%		BUN/（mmol/L）			Scr/（μmol/L）		UA/（μmol/L）
NC组	1.53±0.30				2.33±0.58				1.41±0.11	0.92±0.14			4.94±0.41		5.00±0.77			64.25±11.14		300.03±53.98
SDM组	1.34±0.41^a				3.09±1.40^a				1.37±0.29	1.03±0.29			7.97±2.72^a		5.94±1.61			62.92±8.01		307.08±78.65
DKD组	1.23±0.42^a				3.19±1.22^a				1.33±0.34	1.07±0.37^a			8.28±3.23^a		9.83±4.41			97.23±46.85^ab		348.37±115.44^ab
F	9.226^＊＊				4.487^＊				1.376	3.865^＊			22.054^＊＊		1.122			5.401^＊＊		5.704^＊＊
组别		UACR/ （mg/g）					eGFR/ [mL/（min·1.73 m²）]				NAG/Ucr/ （U/g）			C1q/（g/L）			MBL/ （mg/L）				C5a/ （μg/L）
NC组		5.00（4.00，7.00）					114.92（103.54，128.15）				3.71（3.07，4.97）			0.190±0.035			9.33（5.34，13.53）				136.86±36.27
SDM组		5.00（2.00，10.25）					124.84（112.99，137.34）				5.19（3.90，6.90）^a			0.199±0.044			9.06（4.70，12.48）				157.19±41.58
DKD组		188.00（75.00，721.75）^ab					118.35（74.72，149.39）				10.36（6.50，14.96）^ab			0.215±0.046^ab			12.48（6.80，21.46）^ab				181.70±58.83^ab
F或H		170.793^＊＊					2.106				95.206^＊＊			6.295^＊＊			18.224^＊＊				13.573^＊＊

组别			n	年龄/岁		性别（男/女）		BMI/（kg/m²）				吸烟史	SBP/mmHg			DBP/mmHg			TG/（mmol/L）			TC/（mmol/L）
NC组	40	56.22±8.27		20/20		24.88（22.85，27.25）				8	121.30±6.35			78.85±3.96			1.18±0.43			3.75±0.71
SDM组			50	58.78±11.53		27/23		25.69（23.09，28.23）				17	125.32±8.32			81.50±6.98			1.73±0.54			5.07±1.33^a
DKD组			182	59.55±11.03		94/88		26.88（23.75，29.45）				47	139.71±10.85^ab			84.00±7.03^ab			2.36±1.11^ab			5.22±1.69^a
F、χ²或H				16.660		0.150		5.635				2.356	82.377^＊＊			10.911^＊＊			7.686^＊＊			15.330^＊＊
组别	HDL-C/（mmol/L）				LDL-C/（mmol/L）				ApoA1/（g/L）	ApoB/（g/L）			HbA1c/%		BUN/（mmol/L）			Scr/（μmol/L）		UA/（μmol/L）
NC组	1.53±0.30				2.33±0.58				1.41±0.11	0.92±0.14			4.94±0.41		5.00±0.77			64.25±11.14		300.03±53.98
SDM组	1.34±0.41^a				3.09±1.40^a				1.37±0.29	1.03±0.29			7.97±2.72^a		5.94±1.61			62.92±8.01		307.08±78.65
DKD组	1.23±0.42^a				3.19±1.22^a				1.33±0.34	1.07±0.37^a			8.28±3.23^a		9.83±4.41			97.23±46.85^ab		348.37±115.44^ab
F	9.226^＊＊				4.487^＊				1.376	3.865^＊			22.054^＊＊		1.122			5.401^＊＊		5.704^＊＊
组别		UACR/ （mg/g）					eGFR/ [mL/（min·1.73 m²）]				NAG/Ucr/ （U/g）			C1q/（g/L）			MBL/ （mg/L）				C5a/ （μg/L）
NC组		5.00（4.00，7.00）					114.92（103.54，128.15）				3.71（3.07，4.97）			0.190±0.035			9.33（5.34，13.53）				136.86±36.27
SDM组		5.00（2.00，10.25）					124.84（112.99，137.34）				5.19（3.90，6.90）^a			0.199±0.044			9.06（4.70，12.48）				157.19±41.58
DKD组		188.00（75.00，721.75）^ab					118.35（74.72，149.39）				10.36（6.50，14.96）^ab			0.215±0.046^ab			12.48（6.80，21.46）^ab				181.70±58.83^ab
F或H		170.793^＊＊					2.106				95.206^＊＊			6.295^＊＊			18.224^＊＊				13.573^＊＊

组别	n	C1q/（g/L）	MBL/（mg/L）	C5a/（μg/L）
SDM组	50	0.199±0.044	9.06（4.70，12.48）	157.19±41.58
LDKD组	90	0.203±0.038	11.27（6.15，18.25）^a	159.47±46.44
MDKD组	55	0.204±0.042	14.20（6.84，24.79）^ab	202.30±61.08^ab
HDKD组	37	0.259±0.051^abc	18.49（11.03，25.22）^ab	205.16±63.43^ab
F或H		18.451^＊＊	24.085^＊＊	13.629^＊＊

组别	n	C1q/（g/L）	MBL/（mg/L）	C5a/（μg/L）
SDM组	50	0.199±0.044	9.06（4.70，12.48）	157.19±41.58
LDKD组	90	0.203±0.038	11.27（6.15，18.25）^a	159.47±46.44
MDKD组	55	0.204±0.042	14.20（6.84，24.79）^ab	202.30±61.08^ab
HDKD组	37	0.259±0.051^abc	18.49（11.03，25.22）^ab	205.16±63.43^ab
F或H		18.451^＊＊	24.085^＊＊	13.629^＊＊

组别		n	TG/（mmol/L）		TC/（mmol/L）		HDL-C/（mmol/L）		LDL-C/（mmol/L）		ApoA1/（g/L）		ApoB/（g/L）		HbA1c/%
Q1组		45	1.97±0.72		4.81±1.26		1.20±0.32		3.66±1.92		1.31±0.25		0.99±0.28		7.23±2.66
Q2组		45	1.91±0.83		4.98±1.75		1.27±0.43		3.03±1.18		1.31±0.36		1.02±0.38		8.03±3.32
Q3组		46	2.79±1.83		5.28±1.54		1.21±0.36		3.14±1.00		1.31±0.31		1.06±0.31		8.73±2.78^a
Q4组		46	2.24±1.24		5.67±1.74^ab		1.35±0.50		3.54±1.33		1.41±0.36		1.19±0.40^ab		8.86±3.44^a
F			2.374		3.273^＊		1.656		0.741		1.282		3.896^＊		3.484^＊
组别	BUN/（mmol/L）			Scr/（μmol/L）		UA/（μmol/L）		UACR/（mg/g）		C1q/（g/L）		MBL/（mg/L）		C5a/（μg/L）
Q1组	5.91±1.56			61.55±12.31		337.71±84.55		35.50（5.75，106.50）		0.195±0.036		10.03（5.32，13.14）		152.49±45.02
Q2组	14.02±8.24			82.28±33.03		312.58±98.45		70.50（10.50，230.25）^a		0.206±0.052		11.22（5.57，20.04）		170.27±57.94
Q3组	7.49±3.58			101.17±56.84^a		364.31±130.77		288.50（68.75，566.50）^ab		0.219±0.045^a		13.17（8.11，21.85）		179.86±52.75^a
Q4组	8.55±4.17			114.33±59.48^ab		343.29±116.10		736.50（111.50，1 524.50）^abc		0.225±0.048^ab		12.37（7.52，22.10）		203.05±58.04^abc
F或H	1.220			4.223^＊＊		2.214		56.700^＊＊		4.984^＊＊		8.544		8.924^＊＊

C1q、MBL、C5a与2型糖尿病肾脏病进程及肾小管损伤的相关性

The correlation between C1q, MBL, C5a and the progression of type 2 diabetes nephropathy and tubular injury

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变量	β	SE	Wald χ²	P	OR	OR 95%CI
MBL	0.037	0.016	5.481	0.019	1.037	1.006~1.069
C5a	0.006	0.003	4.625	0.032	1.006	1.001~1.012
NAG/Ucr	0.054	0.016	11.020	0.001	1.055	1.022~1.089
Scr	0.059	0.009	43.891	<0.001	1.061	1.042~1.079
SBP	0.341	0.038	79.455	<0.001	1.406	1.304~1.515
常数项
LDKD vs. SDM	13.340	2.252	35.078	<0.001	6.215×10⁵	7.520×10³~5.136×10⁷
MDKD vs. SDM	17.101	2.425	49.742	<0.001	2.673×10⁷	2.307×10⁵~3.097×10⁹
HDKD vs. SDM	21.332	2.659	64.359	<0.001	1.838×10⁹	1.002×10⁷~3.370×10¹¹

变量	β	SE	Wald χ²	P	OR	OR 95%CI
C5a	0.006	0.002	6.742	0.009	1.006	1.002~1.011
HbA1c	0.141	0.042	11.371	0.001	1.151	1.061~1.249
UACR	0.002	0.003	31.297	<0.001	1.002	1.001~1.003
常数项
Q2 vs. Q1	1.539	0.522	8.690	0.003	4.662	1.675~12.974
Q3 vs. Q1	2.895	0.545	28.199	<0.001	18.089	6.213~52.662
Q4 vs. Q1	4.358	0.588	54.925	<0.001	78.108	24.669~247.310

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