摘要
目的探讨IgG、C3在成人特发性膜性肾病中的特征。方法回顾性分析2011年4月~2020年3月安徽医科大学附属巢湖医院肾脏内科经超声引导下肾穿病理证实为IMN的65例患者临床资料,根据免疫球蛋白IgG,补体C3的沉积强度分为-组,1+组,2+组和3+组,比较各组临床资料和病理特征。结果65例IMN患者,IgG-组3例,1+组22例,2+组21例,3+组19例。四组间年龄、收缩压、舒张压、WBC、CRP、TG、HDL、LDL、IgA、IgM、C3、C4、BUN、SCr、eGFR、CD4+、CD8+、CD4+/CD8+、球性硬化、节段硬化、系膜增生、小动脉壁增厚、淋巴单核细胞浸润比较,差异无统计学意义(P>0.05);四组白蛋白、TC、24h尿总蛋白及肾小管萎缩及间质纤维化比较,差异有统计学意义(P<0.05);C3-组4例,1+组3例,2+组14例,3+组44例。四组间年龄、收缩压、舒张压、WBC、CRP、TC、TG、HDL、LDL、IgG、IgA、IgM、C4、BUN、SCr、CD8+、球性硬化、节段硬化、系膜增生、小动脉壁增厚比较,差异无统计学意义(P>0.05);四组间白蛋白、24h尿总蛋白、eGFR、CD4^+、CD4^+/CD8^+、肾小管萎缩及间质纤维化、淋巴单核细胞浸润比较,差异有统计学意义(P<0.05);非参数Jonckheer-Terpstra趋势检验显示,血清IgG的浓度与肾脏组织IgG沉积强度无关(P>0.05),而肾脏组织中C3沉积强度越强,血清中C3水平越低(P<0.05)。结论特发性膜性肾病的患者随着免疫荧光IgG、C3沉积强度强度增加,血清中白蛋白水平降低,24h尿蛋白程度加重,肾小管损伤及间质纤维化明显,肾小管萎缩及间质纤维化和淋巴单核细胞浸润增加,且肾组织补体C3随着沉积强度增加,eGFR、CD4^+、CD4^+/CD8^+呈升高趋势,提示IgG、C3检测有助于临床病情的判断。
Objective To explore the characteristics of IgG and C3 in adult idiopathic membranous nephropathy.Methods A retrospective analysis of the clinical data of 65 patients with IMN from the Department of Nephrology,Chaohu Hospital Affiliated to Anhui Medical University,from April 2011 to March 2020,was confirmed by ultrasound-guided nephrocentesis.According to the immunoglobulin IgG,the deposition intensity of complement C3 was divided into-group,1+group,2+group and 3+group.The clinical data and pathological characteristics of each group were compared.Results Of 65 IMN patients,3 were in the IgG-group,22 were in the 1+group,21 were in the 2+group,and 19 were in the 3+group.Age,systolic blood pressure,diastolic blood pressure,WBC,CRP,TG,HDL,LDL,IgA,IgM,C3,C4,BUN,SCr,eGFR,CD4^+,CD8^+,CD4^+/CD8^+,spherical sclerosis,segmental sclerosis between the four groups,mesangial hyperplasia,arteriolar wall thickening,lymphatic mononuclear cell infiltration,the difference was not statistically significant(P>0.05);The four groups of albumin,TC,24h urine total protein,renal tubular atrophy and interstitial fibrosis were compared,the differences were statistically significant(P<0.05);4 cases in C3-group,3 cases in 1+group,and 14 cases in 2+group,44 cases in 3+group.Age,systolic blood pressure,diastolic blood pressure,WBC,CRP,TC,TG,HDL,LDL,IgG,IgA,IgM,C4,BUN,SCr,CD8+,spherical sclerosis,segmental sclerosis,mesangial hyperplasia,small,there was no statistically significant difference in arterial wall thickening(P>0.05);albumin,24h urine total protein,eGFR,CD4+,CD4+/CD8+,renal tubular atrophy and interstitial fibrosis,lymphatic mononuclear cell infiltration among the four groups comparison,the difference is statistically significant(P<0.05);non-parametric Jonckheer-Terpstra trend test shows that the concentration of serum IgG has nothing to do with the intensity of IgG deposition in kidney tissue(P>0.05),and the stronger the intensity of C3 deposition in kidney tissue,the lower the level of C3(P<0.05).Conclusion In patients with idiopathic membranous nephropathy,as the intensity of immunofluorescence IgG and C3 deposition increases,the serum albumin level decreases,the 24 h urine protein level increases,the renal tubular damage and interstitial fibrosis were obvious,and the renal tubular atrophy and interstitial fibrosis and lymphatic mononuclear cell infiltration increased,and with the increase in the deposition intensity of renal tissue complement C3,eGFR,CD4^+,CD4^+/CD8^+ showed an increasing trend,suggesting that IgG and C3 detection could help determine the clinical condition.
作者
牛栋
刘永梅
NIU Dong;LIU Yong-mei(Department of Nephrology,Chaohu Hospital,Anhui Medical University,Chaohu 238000,Anhui,China)
出处
《医学信息》
2020年第19期73-77,共5页
Journal of Medical Information
关键词
IGG
C3
膜性肾病
临床病理
IgG
C3
Membranous nephropathy
Clinicopathology