摘要
目的分析免疫球蛋白(Ig)A肾病患者肾小球系膜IgG及其亚型沉积情况与临床意义。方法回顾性收集2014年3月至2018年12月在温州医科大学附属第一医院接受肾活检及IgG亚型检测的808例IgA肾病患者资料。所有肾活检样本均行常规病理检查和免疫荧光检查。将筛选出的84例原发性IgA肾病患者根据免疫荧光检查结果分为IgA-IgG组28例(系膜区有IgG或其亚型沉积)和IgA组56例(系膜区无IgG沉积),比较两组患者临床病理特征,并分析肾小球系膜IgG沉积及其亚型与临床病理特征的关系。结果808例IgA肾病患者中伴IgG或(和)IgG亚型沉积50例(6.2%),均呈系膜沉积模式,其中IgG阴性但亚型阳性2例;IgG阳性但未检出亚型44例,分别为IgG-IgG1阳性42例(91.3%),IgG-IgG2阳性1例(2.2%),IgG-IgG1-IgG3阳性1例(2.2%),无IgG4阳性。84例原发性IgA肾病患者中位随访时间26.0(16.0,33.8)个月,IgA-IgG组和IgA组基线资料(性别、年龄、体质指数、高血压史)、肾脏病理牛津分型(系膜细胞增生、内皮细胞增生、节段性硬化或粘连、肾小管萎缩或间质纤维化面积占肾皮质>25%、细胞/纤维细胞性新月体的占比)、免疫荧光沉积[IgA沉积强度及IgA伴肾小球毛细血管壁沉积、IgM、补体(C)3、C1q、C4、κ轻链、λ轻链]及临床指标(平均动脉压、蛋白尿评分、血浆白蛋白、血清肌酐、估算的肾小球滤过率)比较差异均无统计学差异(均P>0.05)。两组随访时间、平均时间蛋白尿评分、蛋白尿完全缓解率、蛋白尿完全缓解时间、蛋白尿完全缓解累积概率及肾素-血管紧张素系统抑制剂、糖皮质激素和免疫抑制剂和扁桃体切除术的使用比较差异均无统计学意义(均P>0.05)。结论IgA肾病患伴IgG系膜沉积少见且以IgG1为主,对临床病理指标及对蛋白尿的短期转归无明显影响。
Objective To analyze the distribution and clinical significance of IgG subclass deposition in the glomerular mesangium of patients with immunoglobulin A nephropathy(IgAN).Methods A total of analyzed 808 IgAN patients who underwent renal biopsy and IgG subclass detection at the First Affiliated Hospital of Wenzhou Medical University between March 2014 and December 2018 were retrospectively analyzed.All biopsy specimens were examined by light microscopy and immunofluorescence staining.Among these,84 biopsy-proven primary IgAN patients were stratified into two groups based on the immunofluorescence results:the IgA-IgG group(28 cases,with mesangial IgG or its subclass deposition)and the IgA group(56 cases,without mesangial IgG deposition).A comparative analysis of clinicopathological characteristics was performed between the two groups,and the association between mesangial IgG and its subclass deposition and clinicopathological parameters was further investigated.Results Among the 808 IgAN patients,50 cases(6.2%)demonstrated IgG and/or subclass deposition,all exclusively exhibiting a mesangial deposition pattern,among which 2 cases were negative for IgG but positive for the subtypes.There were 44 cases with postive IgG but no subtyes detected,among them IgG-IgG1 positivity was identified in 42 cases(91.3%),followed by IgG-IgG2 in one cases(2.2%)and IgG-IgG1-IgG3 in one case(2.2%),with no IgG4-positive cases observed.The median follow-up time for the 84 patients with primary IgAN was 26.0(16.0,33.8)months.No significant differences were observed between the IgA-IgG group and the IgA group in baseline characteristics(sex,age,Body Mass Index,and history of hypertension),renal Oxford Classification scores(mesangial cell proliferation,endothelial cell proliferation,segmental sclerosis/adhesion,tubular atrophy/interstitial fibrosis>25%of the renal cortex,and proportion of cellular/fibrocellular crescents),immunofluorescence profiles[IgA deposition intensity and IgA accompanied by deposition on the walls of glomerular capillaries,IgM,complement(C)3,C1q,C4,κandλlight chains],and clinical parameters(mean arterial pressure,proteinuria score,serum albumin,serum creatinine,and estimated glomerular filtration rate)(all P>0.05).There were also no statistically significant differences between the two groups in follow-up duration,time-averaged proteinuria score,complete remission rate of proteinuria,time to complete remission of proteinuria,cumulative probabilities of complete proteinuria remission,and usage of renin-angiotensin system inhibitors,glucocorticoids,immunosuppressants and tonsillectomy(all P>0.05).Conclusion Mesangial IgG deposition is uncommon among patients with IgAN,predominantly involving the IgG1 subclass,which demonstrates no significant impact on clinicopathological parameters and short-term proteinuria outcomes.
作者
吴谷
陈孝倩
吕吟秋
陈波
李铎
黄朝兴
WU Gu;CHEN Xiaoqian;LYU Yinqiu;CHEN Bo;LI Duo;HUANG Zhaoxing(Department of Pathology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325006,China;不详)
出处
《浙江医学》
2025年第10期1008-1013,共6页
Zhejiang Medical Journal
