摘要
目的探讨特发性膜性肾病（IMN）和继发性膜性。肾病（SMN）。肾小球免疫荧光IgG亚型的不同表现，评价免疫荧光法IgG亚型在鉴别特发性膜性肾病和膜性狼疮性肾炎（MLN）中的价值。方法本研究总结了2011年10月至2012年12月于北京协和医院住院行肾脏穿刺活检术、病理改变符合膜性肾病特点并行免疫荧光IgG亚型染色的病例，对其病理类型及肾小球免疫荧光IgG亚型进行统计，同时就诊断为IMN和MLN的病例进行回顾性分析，比较两组在临床表现和肾小球免疫荧光IgG亚型及补体沉积方面的特点，并从中筛选出不同病理指标，对它们的诊断价值进行评价和比较。结果（1）共收集病例214例，其中IMN占81％，MLN占14％，后者在SMN中居首位。（2）IMN组IgG1、IgG3和IgG4强度较高，其中IgG4的强度高于其他IgG亚型，且其强度显著高于MLN组（P〈0．01）；MLN组IgGl和IgG3强度较高，IgG3强度高于其他IgG亚型，但与IMN组差异无统计学意义。（3）肾小球免疫荧光IgG4的受试者特征工作曲线（ROC）的曲线下面积（AUC）为0．814，以强度1为界值诊断灵敏度为91．8％，特异度为46．7％，以强度2为界值诊断灵敏度为84．2％，特异度为70．0％。IgG4与IgG3强度差值的AUC为0．793，以0为界值诊断灵敏度为91．8％，特异度为66．7％。IgC．d．阳性且IgG4≥IgG3的诊断灵敏度为88．9％，特异度为70．0％。补体C1q的AUC为0．979，以强度1为界值诊断灵敏度为93．3％，特异度为94．2％。IgG4阳性且C1q阴性的诊断灵敏度为87．7％，特异度为93．3％。结论（1）经免疫荧光法测定，IMN肾小球以IgG4沉积为主，而MLN以IgG3为主。（2）IgG4强度、IgG4与IgG3强度差值及C1q强度具有较高诊断准确性，IgG4强度还可分别与后两者联合使用，以帮助鉴别IMN与MLN。
Objective To evaluate the diagnostic accuracy of IgG subclasses in differentiating membranous lupus nephritis （MLN） from idiopathic membranous nephropathy （IMN）. Methods A total of 214 patients with membranous nephropathy （MN） who underwent renal biopsy at Peking Union Medical College Hospital from October 2011 to December 2012 were included. All renal biopsy specimens were examined and immunofluorescence staining against IgG1, IgG2, IgG3, IgC,4 as well as C3, Clq and C4 were evaluated. Clinical manifestations and pathological features were compared between MLN patients and IMN patients. Diagnostic accuracy of IgG subclasses and complements were evaluated. Results Among all the patients selected in this study, 81% were diagnosed IMN while 14% were diagnosed MLN. The immunofluoreseence staining showed that IgG4 tended to be highly expressed in IMN and its intensity was significantly higher than that in MLN （P 〈 0.01）. The intensity of IgG3 was higher than other subclasses in MLN. The AUC of IgG4 intensity was 0.814 and its sensitivity was 91.8% and 84.2%, the specificity was 46.7% and 70.0%, when the cut-off point was 1 and 2 respectively. The AUC of the intensity difference between IgG4 and IgG3 was 0.793 and its sensitivity was 91.8% and the specificity was 66.7% when the cut-off point was 0. The sensitivity of IgG4≥1 and IgG4≥IgG3 was 88.9% and the specificity was 70.0%. The AUC of Clq intensity was 0.979 and its sensitivity was 93.3% and the specificity was 94.2% when cut-off point was 1. The sensitivity of IgG4≥1 and Clq 〈 1 was 87.7% and the specificity was 93.3%. Conclusions IgG4 is highly expressed in IMN while IgG3 is highly expressed in MLN by means of immunofluorescence staining. Intensity of IgG4, intensity difference between IgG4 and IgG3 and intensity of Clq are of high diagnostic value in MN. The combination of lgG4 intensity and the latter two markers could be helpful in differentiating MLN from IMN.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2014年第2期85-91,共7页
Chinese Journal of Nephrology
关键词
肾小球肾炎
膜性
狼疮肾炎
荧光抗体技术
IGG亚型
Glomerulonephritis, membranous
Lupus nephritis
Fluorescent antibody technique
IgG subclasses
