疥疮相关性肾小球肾炎临床特点及病因分析

Clinical characteristics and etiologic analysis of scabies-associated glomerulonephritis

目的了解疥疮相关性肾小球肾炎的发病率、临床特点,探讨其发病机制。方法收集綦江区人民医院疥疮患者并随访,通过肾脏专科检查明确是否有疥疮相关性肾小球肾炎,并将患者分为单纯疥疮组(A组)和肾小球肾炎组(B组),检测并比较两组患者发病初期一般临床指标和血清C反应蛋白、补体C3及C4、免疫球蛋白、TNF-α、IL-6、IL-1β及IL-18的差异,同时收集并比较疥疮相关性肾小球肾炎患者临床痊愈前后上述指标的差异。结果 376例疥疮患者中有16例发生疥疮相关性肾小球肾炎,患者主要表现为肾小球源性血尿和(或)轻、中度蛋白尿,经积极治疗疥疮后有12例患者在疥疮治愈2~6个月后肾损伤表现完全消失。B组患者较A组血清CRP、IgG、TNF-α、IL-6和IL-18显著升高,血清C3水平显著降低,其差异均有统计学意义(P<0.05)。12例临床治愈的疥疮相关性肾小球肾炎患者在病情治愈后血清IgG、hs-CRP、TNF-α、IL-6和IL-18显著降低,血清C3明显升高,与发病初期相比差异均有统计学意义(P<0.05)。结论疥疮相关性肾炎大多预后良好,其发生与疥螨感染诱发的免疫和炎症反应密切相关。

Objective To understand the incidence and clinical characteristics of scabies-associated glomerulonephritis and to investigate its pathogenesis. Methods The patients with scabies from.Qijiang District Peoplels Hospital were collected from the outpatient department and divided into the simple scabies group （A） and gI0merulonephritis group （B） according to whether com- plicating glomerulonephritis. The general clinical indicators and serum C-reactive protein（CRP）, complement components C3 and C4,immunoglobulin,TNF-α、IL-6、IL-1β and IL-18 in the early stage of the disease were determined and compared between the two groups. The differences of above indicators were collected and compared between before and after clinical cure in the patients with scabies-associated glomerulonephritis. Results Among 376 cases of scabies, 16 cases developed glomerulonephritis. The clinical manifestations included glomerular hematuria and/or mild-moderate proteinuria. The kidney injury manifestations in 12 cases were completely disappeared at 2-6 months after scabies cure. The levels of serum CRP, IgG,TNF-a,IL-6,and IL-18 in the group B were significantly increased and the serum C3 level was significantly decreased compared with the group A,the differences were statisti- cally significant（P〈0.05）. The levels of serum IgG,hs-CRP,TNF-a,IL-6 and IL-18 after cure in 12 cases of clinically cured scabi- es-associated glomerulonephritis were significantly decreased and the serum C3 level was significantly increased,and the difference was statistically significant compared with the early onset stage（P〈0. 05）. Conclusion The majority of prognosis in scabies-associated glomerulonephritis is good. Its occurrence is closely correlated with immune and inflammatory reactions induced by sarcoptes mites infection.