单纯膜性肾病与膜性肾病合并意义未明单克隆免疫球蛋白血症的差异性探讨

The difference between simple membranous nephropathy and simple membranous nephropathy combined with unknown monoclonal immunoglobulinemia

目的探究单纯膜性肾病(MN)患者与MN合并意义未明单克隆免疫球蛋白血症(MGUS)患者的临床病理特征及短期预后的差异。方法选取经肾穿刺活检确诊为MN且合并MGUS的患者41例(MN合并MGUS组)及单纯MN患者81例(单纯MN组)。收集2组患者一般资料及实验室指标[包括白细胞计数(WBC)、血红蛋白(Hb)、血小板(PLT)、尿素氮(BUN)、血肌酐(Scr)、C反应蛋白(CRP)、红细胞沉降率(ESR)、估算肾小球滤过率(eGFR)等];采用间接免疫荧光法测定血清抗M型磷脂酶A2受体(PLA2R)抗体;采用免疫固定电泳测定MN合并MGUS患者M蛋白分型情况;比较2组患者病理资料差异;随访患者的治疗效果及不良反应发生情况。结果与单纯MN组比较,MN合并MGUS组Hb、PLT、eGFR、抗PLA2R抗体水平降低,BUN、Scr、CRP、ESR水平升高(P<0.05)。MN合并MGUS组单克隆免疫球蛋白多为IgG型[41.5%(17/41)]。2组患者病理资料差异均无统计学意义(P>0.05)。MN合并MGUS组、单纯MN组分别有35例、74例获得随访,MN合并MGUS组治疗后缓解率低于单纯MN组[62.9%(22/35)vs.78.4%(58/74),χ^(2)=3.884,P<0.05];Kaplan-Meier曲线显示,MN合并MGUS组累积完全缓解率低于单纯MN组(Log-rankχ^(2)=8.943,P<0.01)。2组不良反应发生率差异无统计学意义(P>0.05)。结论与单纯MN患者相比,MN合并MGUS患者基线肾功能更差,治疗后肾脏缓解率更低。

Objective To explore the difference in clinical pathological characteris clinical pathological characteristics and short-term prognosis between patients with simple membranous nephropathy(MN)and patients with MN complicated with monoclonal gammopathy of undetermined significance(MGUS).Methods Forty-one patients diagnosed with MN combined with MGUS(the MN combined with MGUS group)and 81 patients with simple MN(the simple MN group)diagnosed by renal biopsy were selected in this study.General data and laboratory indicators were collected in the two groups,including white blood cell count(WBC),hemoglobin(Hb),platelet(PLT),urea nitrogen(BUN),serum creatinine(Scr),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and glomerular filtration rate(eGFR).Indirect immunofluorescence assay was used to detect serum anti-M-type phospholipase A2 receptor(PLA2R)antibody.M protein typing in patients with MN and MGUS was determined by immunofixation electrophoresis.The difference of pathological data was compared between the two groups.The treatment effect and adverse reactions of patients were followed up.Results Compared with the simple MN group,Hb,PLT,eGFR anti-PLA2R antibody were lower in the MN combined with MGUS group,while expression levels of BUN,Scr,CRP and ESR were higher(P<0.05).Most monoclonal immunoglobulins in patients with MN complicated with MGUS were IgG type[41.5%(17/41)].There was no significant difference in pathological data between the two groups(P>0.05).Thirty-five patients in the MN combined with MGUS group and 74 patients in the simple MN group were followed up respectively.The remission rate after treatment in the MN combined with MGUS group was lower than that in the simple MN group[62.9%(22/35)vs.78.4%(58/74),χ^(2)=3.884,P<0.05].The Kaplan-Meier curve showed that the cumulative complete remission rate of the MN combined with MGUS group was lower than that of the simple MN group(Log-rankχ^(2)=8.943,P<0.01).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Compared with simple MN patients,patients with MN and MGUS have worse baseline renal function and a lower post-treatment renal response rates.