老年原发性肾病综合征患者血清免疫学的变化

Immunological changes in the serum of elderly patients with primary nephrotic syndrome

目的：探讨老年原发性肾病综合征（PNS）患者的血清免疫学的变化。方法回顾分析我院2010.09~2013.11月行肾活检的 PNS 年龄≥60岁患者（老年组）的免疫学指标及病理资料,并与同期年龄〈60岁的 PNS 患者（对照组）资料进行比较。结果①两组患者血中 IgG 平均浓度均较正常值低,老年组及对照组降低患者分别占59.3%、78.2%,两组差异有统计学意义（P 〈0.05）；②血中 IgA 水平及 IgA 升高患者的比例及血中 IgG/IgM 比值均为老年组高于对照组,而 IgM 水平老年组低于对照组,差异有统计学意义（P 〈0.05）。血中 C3、C4平均浓度在正常范围,两组差异无统计学意义（P 〈0.05）；③老年组血中 IgG 与尿蛋白、胆固醇呈负相关（r 分别是-0.107,-0.238,P 〈0.05）,与血白蛋白呈正相关（r=0.252,P 〈0.05）,两组结果一致；④老年患者以膜性肾病最常见,而对照组则以 IgA肾病常见。结论①绝大多数老年 PNS 患者伴随有血中 IgG 的降低,老年患者血中 IgA 水平及 IgG/IgM 比值升高,补体变化不大；②老年 PNS 患者血中 IgG 的变化与尿蛋白、血浆白蛋白、胆固醇相关。

Objective To investigate immunological changes in the serum of elderly patients with primary nephrotic syndrome （PNS）.Methods We made a retrospective analysis of clinically relevant immunological parameters and pathological data of PNS patients 60 years old and above （elderly group）in our hospital for kidney biopsy between September 2010 and November 2013.The data of similar patients but younger than 60 years old （control group）were collected for comparison.Results ① The average levels of IgG in serum of the two groups were both lower than the normal level.And the patients with a decreased level accounted for 59.3% in the elderly group and 78.2% in the control group.The results exhibited a significant difference （P 〈0.05）.The elderly group had higher proportions of IgA level in the serum and IgA and IgG/IgM ratio than the control group.The level of IgM in the aged patients,however,was significantly lower than that in the control group （P 〈0.05 ）.The mean concentrations of C3 and C4 in the serum were both in the normal range,and no significant difference was observed （P ＆gt;0.05）.③ IgG had a negative correlation with urinary protein and cholesterol in serum （the values of r were-0.107,-0.238,respectively,P 〈0.05）.However,there was a positive correlation between IgG and albumin （r=0.252,P 〈0.05）.The results in both groups were consistent.④ Membranous nephropathy was the most common pathological type in aged patients while in control group IgA nephropathy was the most common.Conclusion ① The level of IgG in the serum decreases in most aged patients with PNC.The serum IgA and IgG/IgM ratio are elevated while concentrations of C3 and C4 change little.②The change of IgG is correlated with urinary protein, serum albumin and cholesterol in aged patients with PNS.