IgM肾病与单纯系膜增生性肾炎肾病综合征临床病理分析

The clinical and pathological study of IgM nephropathy and mesangial proliferative glomerulonephritis nephrotic syndrome

IgM 肾病(IgMN)是否为一独立疾病,多年来争议颇多。本文就组织学类型同为系膜组织增生、临床表现为肾病综合征的23例 IgMN 与16例单纯系膜增生性肾炎(MsPGN)进行临床病理对比分析,结果表明IgMN 年龄较轻、病程较长、复诊者较多,血清 IgM 水平较高,激素疗效相对较差,与 MsPGN 相比均有显著性差异。IgMN 特征性病理改变主要为肾小球系膜区有弥漫性颗粒状 IgM 沉积,IgM 是唯一或最主要的沉积成分。我们认为 IgMN 是区别于 MsPGN 的一组独立的肾小球疾病。

The controversy whether IgM nephropathy(IgMN)is an independent glomerular disease has been present since Cohen and Bhasin reported it in 1978.Be- cause both IgMN and simple mesangial pro- liferative glomerulonephritis(MsPGN) manifested mesangial tissue proliferation in their histological type,the physicians adopt- ed a negative opinions used to catalogue IgMN into MsPGN.In order to probe into the characteristics of IgMN properly,a clni- cal and patholgical comparison study was made between 23 cases of IgMN and 16 cas- es of MsPGN exclusing IgA nepropathy which all presented nephrotic syndrome. The results demonstrated that the his- tological manifestation was similar in IgMN and MsPGN.The characteristic pathological change in IgMN was that penestrated and granular deposition of IgM detected in mesangial area with immunofluorescence examination,and IgM was single and main depositive component.The clinical data indi- cated that there was no significant differ- ence between IgMN and MsPGN in hyperte- sion,hematuria,low-molecule proteinuria, reversible renal function lesion and choles- terol level.But the patients of IgMN were younger(27.35±9.08 years)than those of MsPGN(38.00±14.76,P<0.05),experi- enced longer course of disease(30.91± 44.90 months vs 10.92±23.41 months,P <0.05),and had significantly higher IgM level of serum(0.185±0.09 g/L vs 0.135 ±0.02 g/L,P<0.01).The IgMN,howev- er,responsed poorly to steroid and was easy to relapse.After 6～8 weeks of steroid treatment,the complete remission rate of IgMN(69.57%)was much lower than MsPGN(93.57%,P<0.05).During the following observation,relapse rate of IgMN in remission cases was higher(43.75%) than those of MsPGN(13.33%). We considered that IgMN was one glomerular disease independent of MsPGN. Otherwise,at the pathological base having similar histological change and obvious im- munopathological difference in the patients of two groups,there was much significant difference between IgMN and MsPGN in many respects.This suggested that the role causing disease of IgM depositing in mesan- gial area requires further study.