IgA肾病患者临床病理改变与多重支原体感染的相关性  

A study of clinicopathological features in patients with IgA nephropathy and the association with my- coplasma multi-infection

作　　者：姜雪[1] 杜园园[1] 许菲菲[2] 章建娜[2] 章慧娣[2] 

机构地区：[1]杭州市中医院肾内科,杭州310000 [2]温州医学院附属第一医院肾内科

出　　处：《中国医师杂志》2013年第9期1183-1186,共4页Journal of Chinese Physician

摘　　要：目的研究IgA肾病（IgAnephropathy，IgAN）患者血液中穿通支原体（mycoplasmapenetrans，Mpe）、肺炎支原体（mycoplasmapneumoniae，Mp）和发酵支原体（mycoplasmaferments，Mf）的检出率，IgA肾病、慢性肾脏病（chronickidneydisease，CKD）患者和健康体检者血液中支原体检出率之间的差异及与临床特点的关系。方法采集经病理检查确诊为IgAN患者的血液标本118例，健康体检者89例，CKD对照组90例。按试剂盒方法提取血清DNA，用PCR技术检测Mpe、Mp及Mf特异性基因片段，阳性标本采用Southernblot方法进行证实。根据IgAN患者支原体感染情况进行分组，结合患者的临床病理资料进行分析。结果（1）IgAN组中Genus、Mpe、Mp、Mf感染阳性率分别为33．05％、16．1％、25．45％和8．47％。CKD疾病对照组中Genus、Mpe、Mp、Mf阳性率分别5．56％、2．22％、5．56％和2．22％。健康对照组中Genus、Mpe、Mp、Mf阳性率分别为3．33％、1．11％、2．22％和0。IgAN组与CKD、健康体检者Genus、Mpe及Mp阳性率相比差异有统计学意义（P〈0．05）。IgAN组中10例同时检测到Mpe、Mp和Mf（多重感染检出率8．47％），CKD组2例（多重感染率为2．22％），两组比较差异有统计学意义（P〈0．05）。（2）10例存在重叠感染的IgAN发病年纪较轻，扁桃体炎和尿路感染病史，镜下红细胞检测及肾间质病理积分比较，多重支原体感染组患者明显重于支原体阴性组，差异有统计学意义（P〈0．05）。结论IgAN中Genus、Mpe及Mp的检出率显著高于健康体检者和CKD患者，存在多重支原体感染的IgAN患者肾问质病理改变较重，本研究提示IgAN的发病或进展可能与支原体感染有关。Objective To investigate the infection rates of mycoplasma penetrans （Mpe）, myco- plasma pneumoniae （Mp） and mycoplasma ferments （Mf） in patients with IgA nephropathy （IgAN）, chro- nic kideny disease （CKD）, and healthy people,to compare the difference of infection rate, and to analyze the association of mycoplasma infection and clinicopathological features in IgAN. Methods Blood sam- ples were collected from 118 patients in IgAN group, 90 patients in CKD group, and 89 cases in health con- trol group. DNA of Mpe, Mp and Mf was detected in plasma by PCR. Positive cases were confirmed by Southern blot. According to mycoplasma infection, IgAN patients were divided into two groups, then ana- lyzed the clinicopatholgical features. Results （1）Genus, Mpe, Mp, and Mf positive rates were 33.05 %, 16. 1% ,25.45%, and 8.47% in IgAN group, respectively; 5. 56%, 2. 22%, 5.56%, and 2.22% in CKD group, respectively; and 3.33%, 1.11%, 2. 22%, and 0 in health group, respectively. Compared with CKD and health group, patients in IgAN group had a higher infection rate in Genus, Mpe, and Mp （ P 〈 0. 05 ）.In IgAN group, 10 patients had three kinds of mycoplasmas infection at the same time, and positive rate was 8.47% much higher than CKD group （ positive rate was 2. 22% ） （ P 〈 0. 05 ）. （2） Based on mycoplasm detection results, IgAN patients were divided into two groups, overlapping infection group and mycoplasma negative group. In overlapping infection group, the mean age of onset was much younger than negative group. Compared with negative group, overlapping infection group had higher tonsillitis and urinary tract in- fection rate, more severe microscopic hematuria and tubulointerstitium lesion （ P 〈 0.05）. Conclusions Patients with IgAN had higher infection rate of Genus, Mpe and Mp, compared with CKD patients and health people. Compared with mycoplasma negative group in IgAN patients, more severe microscopic hema- turia and tubulointerstitium lesion in overlapping infection group, w

关 键 词：肾小球。肾炎 IGA 病理学 支原体感染 肺炎 支原体 支原体 穿透 支原体 发酵 

分 类 号：R692.6[医药卫生—泌尿科学]