肾小球内IgA沉积量对IgA肾病患者系膜病变的影响研究  

Correlation of quantity of glomerular IgA deposition with severity of mesangial lesions in IgA nephropathy

作　　者：叶林峰[1] 陈孝倩[1] 李凡凡[1] 黄朝兴[1] 

机构地区：[1]温州医科大学附属第一医院肾内科,325000

出　　处：《浙江医学》2017年第8期635-637,640,共4页Zhejiang Medical Journal

摘　　要：目的探讨肾小球内IgA沉积量与IgA肾病(IgAN)系膜病变的关系。方法将70例原发性IgAN患者根据系膜细胞增生情况分为无系膜细胞增生(M0)组和有系膜细胞增生(M1)组各35例,两组患者的肾活检组织切片行免疫组织化学IgA染色,采用图像分析软件定量分析肾小球内IgA沉积物面积(Area)、平均光密度(Density mean)、累计光密度(IOD)和IgA沉积面积占肾小球面积比值(Per Area),并比较两组患者的临床参数。结果两组患者性别、年龄、血肌酐、估算的肾小球滤过率、血尿酸、血IgA、血C3、血C4水平及低eGFR、高尿酸血症、高血IgA、低血C3、低血C4、伴有肾小球内皮细胞增生和节段性硬化的发生率比较差异均无统计学意义(均P>0.05)。与M0组相比,M1组患者24h尿蛋白定量较高而血白蛋白水平较低,低白蛋白血症和伴有肾小管间质病变的发生率较高(均P<0.05)。M1组患者IgA沉积物Area、Density mean、Per Area和IOD均高于M0组(均P<0.05)。结论IgAN患者系膜病变的严重程度可能受肾小球内IgA沉积量的影响。Objective To investigate the correlation between the quantity of IgA deposition in glomerulus and the severity of mesangial lesions in IgA nephropathy. Methods Seventy patients with primary IgA nephropathy（IgAN） were enrolled in the study,including 35 cases with mesangial lesions（group M1） and 35 cases without mesangial lesions（group M0）. IgA was detected with immunohistochemical staining in renal tissue and analyzed with the Image Pro Plus（IPP） computer image analysis software. The IgA deposition parameters included the area of deposition（Area）,density of deposition（Density mean）,integral optical density of the deposition（IOD） and the ratio of IgA deposition area to the glomerular area（Per area）. The IgA deposition parameters and clinical parameters were compared between two groups. Results There were no significant differences in gender,age,serum creatinine,uric acid,IgA,complement C3 and complement C4 levels,estimated glomerular filtration rate,and the incidence of low estimated glomerular filtration rate,hyperuricemia,high serum IgA level,low serum complement C3 and C4 levels between two groups. The proportion of patients of segmental sclerosis（S1） and glomerular endothelial cell hyperplasia（E1） in two groups also had no differences（P〈0.05）. Compared with group M0,group M1 had higher levels of 24-h urinary protein,and lower levels of serum albumin. Group M1 also had higher proportion of hypoalbuminemia and higher proportion of tubular atrophy or interstitial fibrosis（≥T1）（P〈0.05）. The Area,Density mean,IOD and Per area levels in group M1 were higher than those in group M0（P〈0.05）. Conclusion The severity of the IgAN mesangial lesions is correlated with the quantity of glomerular IgA deposition in patients with IgA nephropathy.

关 键 词：IGA肾病 IGA沉积 系膜病变 

分 类 号：R692.31[医药卫生—泌尿科学]