IgA肾病的超微结构研究

An ultrastructural study on IgA nephropathy

目的：探讨ＩｇＡ肾病（ＩｇＡＮ）超微结构病变的病理学意义及在本病演化进展中的作用。方法：对１２２例肾活检组织，进行系统的超微结构观察，以半定量的方法对各项超微结构病变进行分级，并和肾小球损伤程度及免疫学类型相对照，进行统计学处理。结果：肾小球系膜旁区大量沉着、基膜内皮下或上皮下沉着、系膜基质溶解、旁区病变、基膜异常以及系膜细胞插入，都是肾小球病变进展过程中较早期的超微病变，其出现频率均和肾小球损伤程度呈正相关，尤其是系膜旁区大量沉着、上皮下、内皮下沉着物及系膜溶解和肾小球损伤程度的关系更为密切。结论：ＩｇＡＮ时免疫复合物在肾小球内沉着的数量及部位对病变进展有很大影响。

Objective:To inquire into the pathological significance of ultrasructural changes and their effect in the progression of IgA nephropathy. Methods: The ultrastrutural changes of renal biopsy specimens taken from 122 cases were studied, and evaluated by semiquantitative method, then compared with the glomerular lesiongrading and immunological types statistically. Results: Massive deposits in paramesangium, mesangiolysis, paramesangial destructive lesions, subendothelial or subepithelial dense deposits in glomeruar capillary wall, glomerular basement membrane abnormalities and mesangial cell interposition were all important changes in earlier stage of IgAN progression, and positive correlations were verified by statistics between them and the glomerular lesion grading. Among them subendothelial or subeptithelial dense deposits, massive deposits in paramesangium and mesangiolysis were more closely related to the glomerular lesion grading. Conclusion: The amount or position of immune deposits in the glomeruli played important role in IgAN progression.