肾小球IgM沉积在成人特发性膜性肾病中的临床意义

Clinical significance of renal IgM deposition in adult idiopathic membranous nephropathy

目的探讨成人特发性膜性肾病(IMN)患者肾小球IgM沉积的临床意义。方法回顾性分析2015年12月至2017年6月安徽医科大学第一附属医院肾脏内科经皮肾活检病理证实为IMN的95例患者,用直接免疫荧光法检测肾小球中IgM的沉积部位和强度,分为IgM阴性组和IgM沉积组,对2组的临床、实验室指标进行比较分析,其中血清抗磷脂酶A2受体抗体测定采用间接免疫荧光法检测,按Ehrenreich-Churg的膜性肾病分期标准进行病理分期。结果IgM沉积组相同性别的血尿酸比较,差异有统计学意义(P<0.05),IgM沉积组总胆固醇、24h尿蛋白、尿纤维蛋白原降解产物、尿胱抑素C较IgM阴性组显著升高,差异有统计学意义(P<0.05);IgM沉积组的病理损伤较IgM阴性组更明显;血免疫球蛋白(IgG、IgA、总IgE、IgM)、白蛋白、肌酐、尿素氮、三酰甘油、高密度脂蛋白胆固醇、非高密度脂蛋白胆固醇、极低密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A、载脂蛋白B、脂蛋白(a),尿系列蛋白中总蛋白、转铁蛋白、视黄醇结合蛋白、N-乙酰-β-D-氨基葡萄糖苷酶、白蛋白、IgG、β2-微球蛋白、α1-微球蛋白及血清抗磷脂酶A2受体抗体与阴性组比较,差异无统计学意义(P>0.05)。结论肾小球IgM沉积的IMN患者血尿酸水平更高,血脂代谢紊乱更明显,尿蛋白程度更重,有继发肾小管损伤可能,病理损伤更明显,提示其病情更严重,对临床病情判断有指导作用。

Objective To explore the relationship between renal IgM deposition and clinicopathologic changes in patients with idiopathic membranous nephropathy（IMN）.Methods A retrospective analysis was made on the clinical data of 95 patients with IMN confirmed by subcutaneous renal biopsy in the First Affiliated Hospital of Anhui Medical University from December2015 to June 2017.The position and degree of IgM in glomeruli were detected by direct immunofluorescence,and then the patients were divided into IgM deposition group and IgM negative group.The serum anti-phospholipase A2 receptor antibody was detected by indirect immunofluorescence,and the pathologic staging was made by Ehrenreich-Churg staging criteria.The clinicopathological and laboratory indexes were analyzed and compared between the two groups.Results The levels of serum uric acid in the same sex group,total cholesterol,24-h urinary protein,urinary FDP and urinary cystatin C in IgM deposition group were significantly higher than those in IgM negative group（P〈0.05）.The pathological damage in the IgM deposition group was more severe than in the IgM negative group（P〈0.05）.Blood immune globulin（IgG,IgA,total IgE and IgM）,serum albumin,serum creatinine,blood urea nitrogen,triglyceride,high density lipoprotein cholesterol,non-high density lipoprotein cholesterol,very low density lipoprotein cholesterol,low density lipoprotein cholesterol,apolipoprotein A,apolipoprotein B,lipoprotein（a）,the urinary protein including total protein,transferrin,retinol binding protein,N-acetyl-β-D-glucosaminidase,albumin,IgG,β2-microglobulin,α1-microglobulin,and serum anti-phospholipase A2receptor antibody showed no significant difference between the two groups（P〉0.05）.Conclusions In the IMN patients with IgM deposition,there was higher blood uric acid level,more obvious disorders of blood lipid metabolism,more severe urinary protein,and more risk of secondary renal tubule injury,suggesting that the disease is more serious.