儿童肾病综合征体液免疫指标与疗效观察

Studies on humoral immunity and curative effects of children with nephritic syndrome

目的 探讨儿童肾病综合征(肾病)免疫球蛋白 IgG、IgA、IgM、IgE及补体C3 水平与肾上腺皮质激素敏感性的关系,以了解肾病的发病机理及指导临床治疗。方法 分别采用散射比浊法检测血清IgG、IgA、IgM、C3 及ELISA法检测血清IgE。结果 原发性肾病患儿与正常对照组比较,血清 IgA、C3 无显著差异,肾病患儿血清 IgG水平明显低于正常儿童,IgM、IgE明显高于正常儿童,单纯性肾病与肾炎性肾病结果一致。而在激素应用方面,单纯性肾病与肾炎性肾病对激素治疗的敏感性有非常显著性差异χ2=18.48(P<0.005);原发性肾病患儿血清 IgG降低组与 IgG正常组对激素治疗的敏感性无显著性差异χ2=1.26(P>0.05),IgE升高组与 IgE正常组对激素治疗的敏感性有非常显著性差异χ2=12.46(P<0.005)。结论 原发性肾病综合征患儿存在免疫球蛋白合成异常,可能与患儿体液免疫紊乱有关。激素治疗的敏感性与 IgG水平高低无关,而与肾病综合征临床分型(单纯性肾病、肾炎性肾病)及 IgE水平高低有关:单纯性肾病对激素治疗敏感;而肾炎性肾病对激素耐药和依赖;IgE升高的肾病患儿对激素治疗敏感,IgE正常的肾病患儿却对激素有耐药和依赖。

Objective To explore the association of serum level of IgG,IgA,IgM,IgE and C 3 with sensitivity of glucocorticoid (prednisone) in primary nephropathic patient,and to understand pathogenesis of primary nephropathy.Methods To detect serum IgG,IgA,IgM and C 3 by scattering turbidimetry and IgE by ELISA.Results Compared to healthy children, patient with primary nephropathy has lower IgG and higher IgM and IgE, and same IgA and C 3 level.Whether simple and nephritic nephropathy has the same results,but they have very significant difference in sensitivity to glucocorticoid (χ 2=18.48,P<0.005). Moreover in primary nephropathy, the lower IgG group and normal IgG group have not difference in glucocorticoid sensitivity,but higher IgE group and normal IgE group are very significantly different (χ 2=12.46,P<0.005).Conclusion The patient with primary nephropathy has abnormal immunoglobulin synthesis that may be caused by humoral immunity inbalance. Sensitivity of glucocorticoid is not associated with IgG level but associated with clinical type of nephropathy(simple and nephritic nephropathy) and IgE level.The simple nephropathy is steroid-responsive,nephritic nephropathy is steroid-resistant or steroid-dependent and nephropathy with higher IgE level is steroid-responsive,the nephropathy with normal IgE level is steroid-resistant or steroid-dependent.