摘要
目的:了解IgA肾病患者血清IgA1半乳糖水平,探索其对于诊断IgA肾病的临床价值.方法:2007年5月至2008年2月在中山大学附属第一医院确诊为IgA肾病的29例患者纳入IgA肾病组,根据临床表现分成孤立性血尿组(n=14),非孤立性血尿组(n=15),按照Lee病理分级分成3组,分别为,Ⅰ级+Ⅱ级组(n=9),Ⅲ级组(n=9),Ⅳ级+Ⅴ级组(n=11).同期本院门诊健康体检者18例纳入正常对照组.同期本院儿科非IgA肾病及过敏性紫癜肾炎的其他肾脏病患者18例纳入疾病对照组.3组受试者年龄、性别构成比较,差异无统计学意义(P>0.05).用蚕豆凝集素(vicia villosa lectin,VVL)亲和ELISA法测定IgA1与VVL的结合力,间接反映IgA1半乳糖水平,分析血清IgA1半乳糖水平对于诊断IgA肾病的临床价值.结果:IgA肾病组血清IgA1与VVL结合力 [(0.34±0.1)U]高于正常对照组[(0.27±0.06)U]及疾病对照组[(0.28±0.07)U],差异有显著性(P<0.05).IgA肾病非孤立性血尿组血清IgA1与VVL结合力[(0.36±0.12)U]高于孤立性血尿组[(0.32±0.08)U](P<0.05).IgA肾病不同病理分级组血清IgA1与VVL结合力比较有差异,其中Ⅰ级+Ⅱ级组最高[(0.39±0.12)U](P<0.05).以正常对照组血清IgA1与VVL结合力的±2s为诊断IgA肾病的临界值,诊断灵敏度为24.1%,特异度为100%,阳性预告值为100%,阴性预告值为45%;以±s为诊断IgA肾病的临界值,灵敏度为44.8%,特异度72.2%,阳性预告值为72.2%,阴性预告值为44.8%.结论:IgA肾病患者血清IgA1半乳糖水平低.检测血清IgA1半乳糖水平对于诊断IgA肾病具有一定临床价值,仍需扩大样本量进一步证实.
Objective :To detect the serum level of IgA1 galactose in patients with IgA nephropathy (IgAN) and to explore its use in diagnosis of IgAN. Methods: From May 2007 to February 2008,29 biopsy-proven IgAN patients registered to the First Affiliated Hospital of Sun Yat-sen University were included in the IgAN group. These IgAN patients were further divided into the isolated hematuria sub-group (n = 14) and non-isolated hematuria group (n = 15) based on clinical manifestations,and also divided into three sub-groups according to pathological grading: grades Ⅰ/Ⅱ group (n =9),grade Ⅲ group (n =9) and grade Ⅳ/Ⅴ group (n = 11). A contemporary cohort of 18 healthy individuals was included in the normal controls group, and another of 18 patients with other renal diseases except IgAN or Henoch-Sehonlein purpura nephritis was included in disease control group. The age and gender distribution were comparable among the groups with no statistical differences ( P 〉 0.05 ). The binding capacity of IgAl to vicia villasa lectin (VVL) as a surrogate for IgAl-galactose level was detected by enzyme linked immunosorbent assay (ELISA). The sensitivity, specificity, positive and negative predictive values for diagnosis of IgAN with IgAl galactose level was analyzed. Results:The binding capacity of IgA11 to VVL was significantly higher in IgAN patients [ (0.34 ± 0. 1 ) U ] than in healthy controls [ ( 0.27 ± 0.06 ) U ] or patients with other renal diseases [ (0.28 ± 0.07 ) U ] ( P 〈 0. 05 ), and in non-isolated hematuria sub-group of IgAN patients [ (0.36 ±- 0. 12) U] than in isolated hematuria sub-group of IgAN patients [ (0.32 ±0.08) U] (P 〈0.05). The VVL binding capacity of IgA1 also differed among pathology-based subgroups, with the highest level found in IgAN patients with grades Ⅰ/Ⅱ [ (0.39 ± 0. 12) U ] ( P 〈 0.05 ). Given (x^-± 2 s) of the VVL-binding capacity of serum IgA1 in normal controls as a critical value, the diagnosis showed a sensitivity of 24. 1%, specificity of 100%, positive predictive value of 100% and negative predictive value of 45%. These figures were 44.8% ,72.2% ,72.2% and 44.8% when (x^-± s) of the VVL-binding capacity of serum IgA1 in normal controls was used as a critical value. Conclusion: Low level of serum IgA1 galactose was found in IgAN patients. Detection of serum IgA1 galactose level by EEISA may have a role in diagnosis of IgAN but need to be further confirmed in a cohort with larger sample size.
出处
《广州医学院学报》
2010年第3期36-39,共4页
Academic Journal of Guangzhou Medical College
关键词
IGA肾病
糖链异常IgA1
蚕豆凝集素
酶联免疫吸附法
IgA nephropathy
underglycosylated IgA1
vicia villosa lectin
enzyme linked immunosorbent assay