尿液IgG4检测在特发性膜性肾病诊断中临床意义的研究

The Clinical Significance of Urine IgG4 Test in Idiopathic Membranous Nephropathy

目的探讨特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者检测尿液IgG4的临床意义,为临床诊断IMN寻找敏感的无创伤性指标,提高IMN的诊断和鉴别诊断水平。方法纳入2016年6月至2017年5月在我科住院行肾活检病理诊断为膜性肾病(membranous nephropathy,MN)以及同期确诊为肾小球微小病变(minimal change disease,MCD)的患者,依据临床表现、肾穿刺活检肾组织病理特征、实验室检查等指标,检查是否存在继发因素,将MN患者分为两组:IMN组和继发性膜性肾病(secondary membranous nephropathy,SMN)组,以MCD患者为对照。所有患者均为初次治疗。检测血清学指标及尿液指标,同时检测患者的尿液IgG4水平。进一步将IMN患者不同临床分期进行上述指标的比较。结果①三组尿蛋白、血清白蛋白、肝功能、肾功能、血糖、血脂、尿酸等实验室检查指标比较差异均无统计学意义(P>0.05)。②与SMN组及MCD组比较,IMN组患者尿液IgG4水平升高(P<0.01),而SMN组与MCD组尿液IgG4水平比较差异无统计学意义(P>0.05)。③IMN依据肾脏病理改变分期,I期患者23例(63.89%),II^III期患者13例(36.11%)。尿液IgG4水平I期组与II^III期组比较差异无统计学意义(P>0.05)。结论 IMN患者尿液IgG4水平增高,检测IMN患者尿液IgG4水平可作为一项临床诊断IMN及进行相关鉴别诊断的无创伤性指标。尿液IgG4水平对IMN病理改变分期程度的评估有待进一步研究。

Objective To investigate the clinical significance of detecting urinary IgG4 in patients with idiopathic membranous nephropathy(IMN),to find sensitive non-invasive indicators for clinical diagnosis of IMN,and to improve the diagnosis and differential diagnosis of IMN.Methods Patients who underwent renal biopsy from June 2016 to May 2017 were diagnosed as membranous nephropathy(MN)and minimal change disease(MCD)in the same period.According to clinical manifestations,renal biopsy renal tissue pathological features,laboratory tests and other indicators,whether there were secondary factors was checked.MN patients were divided into two groups:IMN group and secondary membranous nephropathy(SMN)group,MCD patients as a control.All patients were initially treated.The serological indicators and urine indexes of the subjects were recorded at the time of renal biopsy,and the urine IgG4 levels of the patients were also measured.Further the above indicators with different clinical stages of IMN patients were compared.Results①There were no significant differences in urine protein,serum albumin,liver function,renal function,blood glucose,blood lipids and uric acid between the IMN group,the SMN group and the MCD group(P>0.05).②Urinary IgG4 levels were elevated in the IMN group compared with the SMN and MCD groups(P<0.01),while there was no significant difference in urine IgG4 levels between the SMN group and the MCD group(P>0.05).③According to the severity of renal pathology,23 patients(63.89%)in stage I,13 patients(36.11%)in stage II^III.There was no significant difference in urine IgG4 levels between the stage I group and the stage II^III group(P>0.05).Conclusion The level of urinary IgG4 in patients with IMN is increased.The detection of urinary IgG4 levels in patients with IMN can be used as a non-invasive indicator for clinical diagnosis of IMN and related differential diagnosis.The evaluation of the level of IgG4 in urine on the staging of IMN needs further study.