乙肝相关性膜性肾病中IgG亚型的表达及意义  

Expression of IgG subclasses and its significance in hepatitis B virus associated membranous nephropathy

作　　者：刘金荣[1] 汪蕾[2] 杜文军[3] 甄军晖[4] 

机构地区：[1]济宁市第一人民医院肾内科,山东济宁272111 [2]山东大学齐鲁医院镇痛科,济南250012 [3]济南市传染病医院肝病科,济南250021 [4]山东大学医学院病理教研室,济南250012

出　　处：《山东大学学报（医学版）》2012年第10期111-114,共4页Journal of Shandong University:Health Sciences

基　　金：山东省自然科学基金(ZR2011HM083);山东大学自主创新基金(2010TS101)

摘　　要：目的检测和比较乙肝病毒相关性膜性肾病(HBV-MN)和原发性膜性肾病(IMN)中IgG亚型(IgG1、IgG2、IgG3、IgG4)组间及组内的表达差异,探讨IgG亚型在二者诊断和鉴别诊断中的应用价值。方法 32例肾活检确诊为乙肝病毒相关性膜性肾病病例为实验组,20例原发性膜性肾病为对照组,分别进行IgG各亚型的免疫荧光染色。结果实验组中30例肾组织以IgG1沉积为主,6例出现IgG4阳性表达,其中5例同时伴有IgG1沉积,21例IgG2阳性,13例IgG3阳性。对照组中19例以IgG4沉积为主,15例可见IgG1沉积,但以弱阳性为主,伴有IgG2阳性7例,IgG3阳性4例。结论乙肝病毒相关性膜性肾病以IgG1沉积为主,原发性膜性肾病以IgG4沉积为主,可伴有IgG1。两组间IgG1阳性率无明显差异,但实验组的表达强度明显高于对照组。结果提示二者发病机制不同可能引起不同类型的免疫复合物的沉积,IgG4与IgG1有望成为二者鉴别诊断的有应用价值的生物学指标。Objective To detect and compare the expression levels of four IgG subclasses （IgG1, IgG2, IgG3 and IgG4） in glomeruli between hepatitis B viral clearance membranous nephropathy （HBV-MN） and idiopathic membra- nous nephropathy （IMN）, and to explore the role of IgG subclasses in the diagnosis and differential diagnosis in ne- phropathy. Methods Immunofluorescence was utilized to determine the expressions of IgG1 ~ IgG2, IgG3, IgG4 in kidney biopsy tissues from 32 patients with HBV-MN and 20 patients with IMN. Results Among the 32 cases of pa- tients with HBV-MN, deposition of IgG1 was identified in 30 cases; IgG4 was positively expressed in 6 cases, and 5 out of these 6 cases were with simultaneous IgG1 deposition; IgG 2 was expressed in 21 cases, and IgG3 was positive in 13 cases. By contrast, deposition of IgG4 was identified in 19 cases with IMN; IgG1 deposition was present in 15 ca- ses, but with weak expression only ; Expressions of IgG2 and IgG3 were present in 7 and 4 cases, respectively. Conclu- sion IgG1 deposition is mainly present in HBV-MN , but IgG4 deposition is mainly present in IMN, sometimes with IgG1 together. The positive rate between the two groups has no significant difference, but the expression intensity of the HBV-MN group is significantly higher than that of the IMN group. The different patterns of immune complex deposition suggest that the pathogenesis of HBV-MN differs from that of IMN. IgG4 and IgG1 may be the valuable biological indi- cator in diagnosis and differential diagnosis for IMN and HBV-MN.

关 键 词：IGG亚型 原发性膜性肾病 乙肝病毒相关性膜性肾病 

分 类 号：R692.6[医药卫生—泌尿科学]