| 摘要: |
| 目的 分析IgA肾病患者肾小球系膜IgG亚型沉积情况与临床意义。 方法 回顾2014年3月至2018年12月在温州医科大学附属第一医院经肾活检组织免疫荧光法检查IgG亚型的808例IgA肾病，继发性IgA肾病及继发性肾小球内IgG沉积的合并病症已被排除。所有这些病例均经直接免疫荧光法检查IgG亚型，其中含IgG亚型（伴或不伴IgG）系膜沉积者46例，无IgG和IgG亚型沉积者758例。按照入组标准和排除标准，在含IgG亚型（伴或不伴IgG）系膜沉积者46例中筛选出IgA-IgG组28例，在无IgG和IgG亚型沉积者758例随机筛选出IgA组56例。比较不同分组患者基线的临床病理资料、随访情况及用药等,肾小球肾炎病变参照牛津IgA肾病病理评分(MEST-C)进行评估。 结果 （1）在808例IgA肾病中，仅50例（6.2%）伴IgG沉积，均呈系膜沉积模式。（2）在含IgG亚型的46例中，IgG1合计阳性44例（95.7%），IgG2合计阳性2例（4.3%），IgG3（伴IgG1）阳性1例（2.2%），IgG4无一例阳性。（3）患者的发病年龄、性别、BMI、M1、E1、S1、T(T1+T2）和C(C1+C2）等的发生率在IgA组和IgA-IgG组两组间的差异均无统计学意义，IgA免疫荧光强度、IgM沉积、C3、C1q、C4沉积、轻链κ和λ沉积及伴肾小球毛细血管壁IgA沉积的发生率在两组间的差异均无统计学意义；诊断时的血压、蛋白尿、ALB、Scr、eGFR及合并高血压的发生率在两组间的差异也均无统计学意义。所有入组者平均随访26个月，平均时间蛋白尿、蛋白尿完全缓解率、蛋白尿完全缓解时间在两组间的差异均无统计学意义；蛋白尿完全缓解累积概率在两组间的差异无统计学意义；使用RASI、糖皮质激素和免疫抑制剂在两组间的差异也均无统计学意义。结论 在接受肾活检组织免疫荧光检查的IgA肾病患者中，伴IgG系膜沉积少见，伴系膜IgG亚型沉积主要是IgG1。伴IgG沉积对IgA肾病诊断时的临床病理指标无明显影响，对蛋白尿的短期转归也无明显影响。 |
| 关键词: IgA肾病 IgG IgG亚型 半乳糖缺陷的IgA1 自身抗体 |
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| Evaluation of the Distribution and Clinical Significance of IgG and its Subclasses in Mesangial Deposits of Patients with IgA Nephropathy |
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Wu Gu, Chen Xiaoqian, Lv Yinqiu, Chen Bo, Li Duo, Huang Zhaoxing
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the First Affiliated Hospital of Wenzhou Medical University
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| Abstract: |
| Objective Analysis of IgG subclasses deposition in the glomerular mesangial of patients with IgA nephropathy and clinical significance. Methods We reviewed 808 cases of IgA nephropathy with IgG subclasses examined by immunofluorescence method of renal biopsy tissues from March 2014 to December 2018 in the First Affiliated Hospital of Wenzhou Medical University.The comorbidities of secondary IgA nephropathy and secondary intraglomerular IgG deposition had been excluded. All these cases were investigated for IgG subclasses by direct immunofluorescence, including 46 cases with IgG subclasses (with or without IgG) mesangial deposits and 758 cases without IgG or IgG subclass deposits. According to the inclusion and exclusion criteria, 28 cases of the IgA-IgG group were screened out of the 46 cases of those with IgG subclass (with or without IgG) mesangial deposits, and 56 cases of the IgA group were randomly screened out of the 758 cases of those without IgG or IgG subclass deposits. Clinicopathologic data, follow-up, and medications at baseline were compared between subgroups of patients, and glomerulonephritis lesions were assessed using the Oxford Pathologic Score for IgA Nephropathy (MEST-C). Results Of the 808 cases of IgA nephropathy, only 50 (6.2%) were associated with IgG deposition, all with a mesangial deposition pattern. Of the 46 cases containing IgG subclasses, 44 (95.7%) were positive for IgG1 combined, 2 (4.3%) were positive for IgG2 combined, 1 (2.2%) was positive for IgG3 (with IgG1), and none were positive for IgG4. The differences in the incidence of clinical and pathological features between the IgA group and IgA-IgG group, including age of onset, gender, BMI, M1, E1, S1, T(T1+T2), and C(C1+C2), all showed no statistical significance. Similarly, there were no statistically significant differences between the two groups in IgA immunofluorescence intensity, IgM deposition, complement 3/1q/4 deposition, κ/λ light chain deposition, or the incidence of glomerular capillary wall IgA deposition. The differences in blood pressure, proteinuria, ALB, Scr, eGFR and the incidence of combined hypertension at the time of diagnosis were also not statistically significant between the two groups. All enrollees were followed up for an average of 26 months, and the differences in mean time to proteinuria, rate of complete remission of proteinuria, and time to complete remission of proteinuria were not statistically significant between the two groups; the differences in cumulative probability of complete remission of proteinuria were not statistically significant between the two groups; and the differences in the use of RASI, glucocorticoids, and immunosuppressants were also not statistically significant between the two groups. Conclusion In patients with IgA nephropathy who underwent immunofluorescence examination of renal biopsy tissues, concomitant IgG mesangial deposition was rare, and concomitant mesangial IgG subclasses deposition was predominantly IgG1. Concomitant IgG deposition did not have a significant effect on clinicopathologic indices at the time of diagnosis of IgA nephropathy, nor did it have a significant effect on the short-term regression of proteinuria. |
| Key words: IgA nephropathy IgG IgG subclasses Galactose-deficient IgA1 Autoantibodies |