原发性IgA肾病患者肾脏IgM沉积情况与其临床症状及病理特征关系探讨

The relationship between renal IgM deposition and clinical symptoms and pathological features in patients with primary IgA nephropathy

目的:探讨原发性IgA肾病患者肾脏IgM沉积情况与其临床症状及病理特征关系。方法:选取2016年6月~2019年6月于我院就诊的145例原发性IgA肾病患者作为研究对象,将患者按检查结果分为两组,即IgM沉积组(72例)和IgM阴性组(73例),对比两组临床症状和病理特征关系。结果:两组高血压、平均舒张压、平均收缩压、水肿和肉眼血尿均差异不显著,IgM沉积组血尿和肾病综合征明显比IgM阴性组更多;IgM沉积组尿白蛋白、尿转铁蛋白、尿总蛋白、24h尿蛋白/肌酐、24h尿蛋白定量和尿IgG水平明显高于IgM阴性组,两组尿RBP水平差异不显著;两组血肌酐、血IgM、血IgA水平差异不显著,IgM沉积组血尿素氮明显高于IgM阴性组,血白蛋白、eG-FR、血IgG水平明显低于IgM阴性组,IgM沉积组CKD分期明显重于IgM阴性组;IgM沉积组Lee氏分级Ⅳ级多于IgM阴性组,但差异差异不显著,IgM沉积组T1和T2明显多于IgM阴性组,T0明显低于IgM阴性组,IgM沉积组M1、E1和S1多于IgM阴性组,但差异差异不显著,IgM沉积组肾小管间质积分和总积分明显高于IgM阴性组。结论:原发性IgA肾病IgM沉积患者与IgM阴性患者相比,其临床表现更严重,尿蛋白水平明显更高,肾小球损伤更重,其总的病理损害更为显著。

Objective To investigate the relationship between renal IgM deposition and clinical symptoms and pathological features in patients with primary IgA nephropathy.Methods 145 patients with primary IgA nephropathy who were treated in our hospital from June 2016 to June 2019 were selected as the subjects.According to the results of the examination,the patients were divided into two groups:IgM deposition group(72 cases)and IgM negative group(73 cases).The relationship between clinical symptoms and pathological characteristics was compared between the two groups.Results There were no significant differences in hypertension,mean diastolic pressure,mean systolic pressure,edema and gross hematuria between the two groups.Hematuria and nephrotic syndrome in IgM deposition group were significantly more than those in IgM negative group.Urinary albumin,urinary transferrin,urinary total protein,24-hour urinary protein/creatinine,24-hour urinary protein quantification and urinary IgG levels in IgM deposition group were significantly higher than those in IgM negative group.There was no significant difference in urinary RBP level between the two groups;there was no significant difference in serum creatinine,serum IgM and serum IgA levels between the two groups;serum urea nitrogen in the IgM deposition group was significantly higher than that in the IgM negative group;serum albumin,eG-FR and serum IgG levels were significantly lower than those in the IgM negative group;CKD stage in the IgM deposition group was significantly heavier than that in the IgM negative group;Lee’s grade IV in the IgM deposition group was more than that in the IgM negative group,but worse.There was no significant difference.T1 and T2 in IgM sedimentary group were significantly more than IgM negative group,T0 was significantly lower than IgM negative group.M1,E1 and S1 in IgM sedimentary group were more than IgM negative group,but the difference was not significant.The tubulointerstitial integral and total integral in IgM sedimentary group were significantly higher than IgM negative group.Conclusion Compared with IgM negative patients,IgM deposition patients with primary IgA nephropathy have more severe clinical manifestations,higher urinary protein levels,more severe glomerular damage and more significant overall pathological damage.