子痫前期肾病综合征子宫蜕膜免疫病理观察

Study on immuno-pathological damage to decidua in preeclampsia nephrotic syndrome.

目的:探讨蜕膜中免疫球蛋白IgG、IgM沉积在子痫前期肾病综合征发病中的作用、及其与肾功能和肾脏病理改变的相关性。方法:用HE染色、免疫组化法,观察正常妊娠妇女(Ⅰ组)、非肾病综合征型子痫前期(Ⅱ组)和子痫前期肾病综合征(Ⅲ组)患者各30例子宫蜕膜血管壁内皮细胞免疫球蛋白IgG、IgM沉积和病理改变,并分析临床肾脏功能结果及Ⅲ组1例产后肾脏病理变化和免疫沉积的相关性。结果:(1)IgG、IgM在Ⅰ、Ⅱ、Ⅲ组子宫蜕膜螺旋形小动脉中染色依次增强,3组差异均有统计学意义(χ2=32.2565,P<0.05;χ2=36.2549,P<0.05);(2)IgG、IgM在子宫蜕膜血管壁内皮细胞中沉积强度与同组24h尿蛋白、血浆BUN、Cr、UA有相同的变化趋势;(3)Ⅲ组1例子痫前期肾病综合征肾脏病变与蜕膜的免疫复合物沉积明显一致。结论:子痫前期肾病综合征患者蜕膜IgG、IgM沉积和血管病变明显,且与肾功能受损和24h尿蛋白的定量有一致的变化趋势。

Objective：The study was to investigate the role of the IgG and IgM deposited on deciduas in the pathogenesis of preeclampsia with nephrotic syndrome.And its correlation with nephrotic function and renal pathological changes was discussed.Methods：IgG and IgM deposited on the endothelial cells of vessel wall,and the pathogenesis changes in deciduas of three groups were observed with HE staining and immunochemistry.Each group involved 30 pregnancy women,and they were normal pregnant women（group Ⅰ）,preeclampsia patients without nephrotic syndrome（group Ⅱ）,and preeclampsia patients with nephrotic syndrome（group Ⅲ）.The data of nephritic function test were analyzed,together with the renal pathological changes and immunological depositon（one patient in group Ⅲ）.Result：（1）On the spiral artery wall in deciduas,IgG and IgM showed notably increased expression in group Ⅲ than other groups（χ2=15.9341,P0.05;χ2=15.9476,P0.05）,while those expression in group Ⅱ was strikingly higher than that in group Ⅰ（χ2=15.9341,P0.05;χ2=15.9476,P0.05）.（2）The depositon of IgG and IgM on the endothelial cells of vessel wall was positively correlated with the 24-hour urine protein,plasma BUN,Cr,UA in each group.（3）The renal pathological changes in one patient in group Ⅲ were clearly consistent with the deposition of immune complex on her decidua.Conclusions：There were significant decidual IgG and IgM depositions and vascular diseases in women suffering preeclampsia with nephrotic syndrome.And there was a consistent positive trend among these changes,the impaired renal function,and the amount of 24h urinary protein.