儿童肾病综合征肾组织病理光镜和免疫荧光分型的关系

The use of light microscope and immunofluorescence in pathology of childhood nephrotic syndrome

目的探讨肾组织光镜病理和免疫荧光病理的相关性。方法回顾性分析410例原发性肾病综合征行经皮肾活检患儿的肾组织病理资料。结果 410例患儿肾组织光镜病理类型分布为:轻微病变(MCNS)133例(32.4%),系膜增生性肾小球肾炎(MsPGN)229例(55.9%),膜增生性肾小球肾炎(MPGN)5例(1.2%),膜性肾小球肾炎(MN)7例(1.7%),局灶节段硬化(FSGS)6例(8.8%)。肾组织免疫荧光病理类型分布为:IgA型41例(10%),IgM型66例(16.1%),IgA+M+G+C3型9例(2.2%),补体为主型8例(2%),无免疫复合物型286例(69.8%)。MCNS、MsPGN、FSGS均以无免疫复合物型多见,MPGN以补体为主型多见,MN型以IgA+M+G+C3型多见。5种不同肾组织光镜病理类型中的免疫荧光类型分布差异有统计学意义(χ2=87.673,P<0.01)。结论5种肾组织光镜病理的免疫荧光病理存在差异。

Objective To explore the correlation between light microscope and immunofluorescence in renal pathology.Methods The renal pathological features of 410 children with primary nephropathy syndrome were reviewed and analyzed retrospectively.Results The renal pathological types of 410 patients were processed by light microscope and showed 133(32.4%)minimal change nephropathy syndrome(MCNS),299(55.9%)mesangioproliferative glomerulonephritis(MsPGN),5(1.2%)membranoproliferative glomerulonephritis(MPGN),7(1.7%)membranous glomerulopathy(MN),and 36(8.8%)focal and segmental glomerulosclerosis(FSGS).The renal pathological types by immunofluorescence were found that IgA was presented in 41 cases(10%),IgM was presented in 66 cases(16.1%),IgA+M+G+C3 was presented in 9 cases(2.2%),complement was presented in 8 cases(2%),and there was no immune complex present in 286 cases(69.8%).Without immune complexes were the most commonly seen in MCNS,MsPGN and FSGS,complement was the most commonly seen in MPGN,and IgA+M+G+C3 were the most commonly seen in MN.There was statistically difference between types of renal pathology in light microscope and types in immunofluorescence(χ2 = 87.673,P < 0.01).Conclusions The renal pathological types in immunofluorescence are significantly different from those in light microscope.