系膜区IgG沉积对IgA肾病临床及病理影响

Clinical and pathological features in IgA nephropathy with IgG deposition in the glomerular mesangial area

目的探讨IgA肾病患者伴系膜区IgG沉积与单纯IgA沉积间临床及病理之间的关系。方法收集自2009年11月~2016年2月于南方医科大学第三附属医院肾活检诊断为IgA肾病患者122例。所有肾活检样本均行光镜、免疫荧光和电镜检查。根据患者免疫荧光结果系膜区有无IgG沉积,将IgA肾病患者分为单纯IgA沉积组(n=63)与IgA-IgG沉积组(n=59)。对所有患者进行Lee分级及牛津分级。对比两组临床及病理差异。结果 IgA肾病伴IgG沉积组临床血肌酐、24小时尿蛋白、血尿酸、甘油三酯水平均高于单纯IgA沉积组(P<0.05);eGFR低于单纯IgA沉积组(P<0.001);病理中有更多的患者处于Lee氏分级IV-V级、肾小管萎缩或/和间质纤维化评分及MEST评分≥3比例多(P<0.05)。结论 IgA肾病系膜区伴IgG沉积患者临床及病理较重,应加强对IgA肾病系膜区伴IgG沉积的认识,延缓IgA肾病的进展。

Objective To investigate the relationship between the clinical and pathological findings in IgA nephropathy with or without IgG deposition in the glomerular mesangial area. Methods The data were collected from 122 patients with a diagnosis of IgA nephropathy by renal biopsy in the Third Affiliated Hospital of Southern Medical University between November,2009 and February,2016. All the samples were examined by light microscopy,immunofluorescence and electron microscopy.According to the results of immunofluorescence assay,the patients were divided into IgA group(n=63) and IgA-IgG group(n=59). The pathological classification of IgA nephropathy was analyzed according to Oxford classification and Lee's classification.The clinical and pathological findings were compared between the two groups. Results Compared with the patients with IgA nephropathy but without IgG deposition,patients with IgA nephropathy with IgG deposition had higher serum creatinine,higher 24-h urine protein,higher blood uric acid,higher triglyceride levels(P<0.05) and lower eGFR(P<0.05); more of these patients were in Lee's grade IV-V,had renal tubular atrophy and/or interstitial fibrosis,and had MEST scores more than 3(P<0.05). Conclusion Patients with IgA nephropathy with IgG deposition in the glomerular mesangial have severer clinical symptoms and more serious pathological changes. Measures should be taken to control IgG deposition in patients with IgA nephropathy to delay the progress of the disease.