Abstract: Background　IgAN is one of the most common primary glomerular diseases worldwide，and it is recognized that the deposition of circulating immune complexes in the glomerular mesangial area initiates the disease.Likewise，the incidence of diabetes mellitus（DM） in China has increased year by year，which has become a major national health problem.Objective　Circulating immune complex （CIC） could promote proliferation and inflammation factors production of glomerular mesangial cells in patients with IgA nephropathy （IgAN），we aimed to investigate if there is functional difference of CIC from patients both with IgAN and DM.Methods　28 patients with primary IgAN （8 both with IgAN and DM，and 20 with IgAN only） who received renal-biopsy in the First Affiliated Hospital of Zhengzhou University were recruited from February 2017 to February 2018.In addition，7 age- and sex-matched physical examinees （as healthy controls） were recruited from the physical examination department of this hospital during the period.Clinical and pathological data of patients with IgAN were collected from medical records.CIC was extracted from 10 ml peripheral blood collected from all participants and was used to stimulate the glomerular mesangial cells at the same concentration，then the mesangial cell proliferation activity was detected by CCK-8 kit and the levels of IL-6 and CXCL1 in the supernatant were tested by commercial ELISA kits.Results　The plasma levels of triglyceride，C3 and C4 in the IgAN group were lower than those both with IgAN and DM.The ratio of patients with E1 （capillary endothelial cell proliferation） in the Oxford classification was higher than that in the IgAN with DM group （P<0.05）.The proliferation activity of the mesangial cells in the three groups was significantly different （P<0.001），in particular，it was higher in the IgAN group than that of other two groups （P<0.05），but there was no significant difference between the IgAN with DM group and the normal group （P=0.250）.As to cell supernatant IL-6 and CXCL1 levels，the result showed there was no difference among the three groups （P>0.05）.Conclusion　It is seemly CIC from patients with both IgAN and DM have the similar ability to promote mesangial cells to produce inflammatory factors as the ones only with IgAN，but lower ability on promoting the proliferation of mesangial cells，which indicated the component of CIC may be different between patients with IgAN only and both with DM.

Key words: Glomerulonephritis, IgA；Diabetes mellitus；Circulating immune complex

摘要： 背景　IgA肾病（IgAN）是目前世界范围内最常见的原发性肾小球疾病之一，目前认为其发病是由肾小球系膜区的循环免疫复合物（CIC）沉积引起。同样，中国糖尿病发病率逐年升高，已成为困扰国民健康的重大难题。目的　CIC可以促进IgAN患者系膜细胞增殖和炎性因子的产生，本研究旨在探索单纯IgAN患者与IgAN合并糖尿病患者CIC的功能差异。方法　选取2017年2月—2018年2月在郑州大学第一附属医院就诊并行肾脏活检确诊的28例原发性IgAN患者，其中单纯IgAN 20例（单纯IgAN组）和IgAN合并糖尿病8例（IgAN合并糖尿病组），另选取同期性别及年龄匹配的本院体检科体检健康者7例（正常组）。收集IgAN患者临床资料和病理资料。采集三组受试者10 ml外周血，提取血浆CIC，用相同浓度刺激人肾小球系膜细胞，采用CCK-8试剂盒检测系膜细胞增殖能力，采用酶联免疫吸附试验（ELISA）试剂盒检测细胞培养上清液白介素6（IL-6）和趋化因子配体1（CXCL-1）水平。结果　单纯IgAN组三酰甘油、C3、C4水平低于IgAN合并糖尿病组，牛津分类中存在内皮细胞增生（E1）患者比例高于IgAN合并糖尿病组（P<0.05）。三组系膜细胞增殖能力比较，差异有统计学意义（P<0.001）；其中单纯IgAN组系膜细胞增殖能力均高于正常组和IgAN合并糖尿病组（P<0.05）；IgAN合并糖尿病组和正常组系膜细胞增殖能力比较，差异无统计学意义（P=0.250）。三组IL-6、CXCL-1水平比较，差异均无统计学意义（P>0.05）。结论　IgAN合并糖尿病患者的CIC与单纯IgAN患者相比，具有相似的促进肾小球系膜细胞产生炎性因子的能力，但促进肾小球系膜细胞增殖的能力较低，表明单纯IgAN患者和IgAN合并糖尿病患者的CIC成分可能不同。

关键词: 肾小球肾炎, IgA, 糖尿病, 循环免疫复合物