IgG、IgG1和IgG4在膜性肾病中的表达及意义

Expressions and significance of IgG,IgG1 and IgG4 in membranous nephropathy

目的通过观察IgG、IgG1和IgG4在膜性肾病(MN)中的表达,分析其在膜性肾病分期中的意义及其鉴别诊断价值。方法收集经肾穿刺活检病理(免疫荧光、光镜、电镜)确诊的144例膜性肾病,对其进行免疫组化IgG亚型的观察,结合临床资料及病理学特点,进行统计的分析,评价在膜性肾病分期中的鉴别诊断价值。结果(1)144例MN中,MN-I占81.9%,MN-II占16.7%,MN-III占1.4%。IgG亚型在各期MN中的分布:MN-I期中,IgG阳性率最高(98.3%),其次为IgG4(86.4%),IgG和IgG4阳性率显著高于IgG1(49.2%),差异显著(P<0.05)。(2)MN-II期中,IgG阳性率最高(100%),其次为IgG4(87.5%),IgG阳性率显著高于IgG1(70.8%),差异显著(P<0.05)。(3)MN-III期中,IgG及IgG1阳性率最高(均为100%),其次为IgG4(50%),IgG和IgG1阳性率显著高于IgG4,差异显著(P<0.05)。结论 (1)经免疫组化方法测定,MN-I期中以IgG沉积为主,MN-II期中以IgG和IgG4沉积为主,MN-III期中以IgG和IgG1沉积为主。(2)IgG、IgG1和IgG4在膜性肾病中具有较高的阳性一致率,有助于各期膜性肾病的鉴别诊断。

Objective To investigate the expression of IgG,IgG1 and IgG4 in membranous nephropathy（MN）,and to retrospectively analyze its significance and value of differential diagnosis in membranous nephropathy（MN）.Methods A total of 144 cases of membranous nephropathy diagnosed by renal biopsy pathology（immunofluorescence,light microscopy,and electron microscopy） in Weifang People＇s Hospital from August 2015 to July 2017 were included in the study.The expression of IgG,IgG1 and IgG4 was determined by immunohistochemistry,and retrospectively analyzed,combined with the clinical data and pathological features.Their value in the differential diagnosis of MN was evaluated.Results A total of 144 cases were included,that MN-I accounted for 81.94%,MN-II accounted for 16.67% and MN-III accounted for 1.39%.IgG subtypes in each phase of the distribution of MN：IgG positive rate（98.31%） was the highest in the MN-I,the second is the IgG4（86.44%）.The positive rate was significantly higher than that of IgG1（49.15%）,IgG and IgG4.The difference was statistically significant（P〈0.05）.In MN-II,IgG positive rate（100%） was the highest,followed by IgG4（87.50%）,IgG positive rate was significantly higher than that of IgG1（70.83%）.The difference was statistically significant（P〈0.05）.In MN-III,IgG,IgG1 positive rate（100%） was the highest,followed by IgG4（50.0%）.The positive rate was significantly higher than that of IgG4（50.0%）,IgG and IgG1.The difference was statistically significant（P〈0.05）.Conclusions Determined by immunohistochemistry,IgG is mainly expressed in MN-I group,IgG and IgG4 are mainly expressed in MN-II group,IgG and IgG1 are mainly expressed in MN-III group.IgG,IgG1 and IgG4 in MN show a high positive concordance rate,contribute to the differential diagnosis of periods of membranous nephropathy.