血清IgA/淋巴细胞在IgA肾病中的水平变化及意义  

Changes and significance of serum IgA/lymphocyte in IgA nephropathy

作　　者：陈雅卓 翟亚玲 张惠雅 高静歌 姚星辰 盛晓笑 王新念 程根阳 CHEN Yazhuo;ZHAI Yaling;ZHANG Huiya;GAO Jingge;YAO Xingchen;SHENG Xiaoxiao;WANG Xinnian;CHENG Genyang(The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院

出　　处：《山东医药》2019年第34期5-9,共5页Shandong Medical Journal

基　　金：河南省科技攻关计划项目(152102310056);河南省自然科学基金资助项目(182300410322);国家自然科学青年基金资助项目(81600555);中国博士后科学基金面上项目(2018M640684)

摘　　要：目的观察血清IgA/淋巴细胞在IgA肾病(IgAN)中的水平变化,并探讨其意义。方法收集经皮肾脏穿刺活检术确诊为原发性IgAN,并随访3个月以上,且有基线血清IgA水平的144例患者资料,以血清IgA/淋巴细胞水平的中位数进行分组。比较高、低血清IgA/淋巴细胞者的性别、年龄、血压、淋巴细胞计数、血红蛋白、血肌酐、血尿酸、血尿素氮、血清白蛋白、胆固醇、甘油三酯、24 h尿蛋白定量、血清免疫球蛋白(IgG、IgM、IgA)、血清补体C3、血清补体C4、尿检红细胞计数、肾组织光镜、免疫组化、电镜、疗效及预后等资料,并进行新牛津分型(MEST-C)。结果144例原发性IgAN患者血清IgA/淋巴细胞为0.963(0.201,1.656),高血清IgA/淋巴细胞者72例、低血清IgA/淋巴细胞者72例。与低血清IgA/淋巴细胞者比较,高血清IgA/淋巴细胞者血清补体C4、24 h尿蛋白定量低(P均<0.05),血清IgA水平高(P<0.05)。不同血清IgA/淋巴细胞者新牛津分型未见统计学差异。高血清IgA/淋巴细胞者血清IgG和C3的沉积率均高于低血清IgA/淋巴细胞者(P均<0.05),但IgA和IgM沉积未见统计学差异。两者肾小动脉损伤均以血管壁增厚且伴其他病变为主,所占比例约为50%。高血清IgA/淋巴细胞者达到终点事件10例,低血清IgA/淋巴细胞者达到终点事件8例,两者预后无统计学差异。高血清IgA/淋巴细胞者治疗无效、部分缓解、完全缓解分别为21、18、33例,低血清IgA/淋巴细胞者分别为28、23、21例,两者相比P=0.060。结论高血清IgA/淋巴细胞IgAN患者的血清补体C4、24 h尿蛋白定量显著降低,肾脏病理改变更重,但与预后无关。Objective To observe the changes of serum IgA/lymphocyte in IgA nephropathy(IgAN)and to explore its significance.Methods Data from 144 patients with primary IgAN diagnosed by percutaneous nephropuncture biopsy and followed up for more than 3 months with baseline serum IgA levels were grouped according to median IgA/lymphocyte levels.We compared the sex,age,blood pressure,lymphocyte count,hemoglobin,serum creatinine,blood uric acid,blood urea nitrogen,serum albumin,cholesterol,triglycerides,24 h urine protein quantitation,serum immunoglobulin(IgG,IgM and IgA),serum complement C3,serum complement C4,urine red blood cell count,renal tissue light microscopy,immunohistochemistry,electron microscopy,efficacy and prognosis between the high IgA/lymphocyte group and low IgA/lymphocyte group,and meanwhile,the new Oxford classification(MEST-C)was performed.Results The serum IgA/lymphocyte ratio of 144 patients with primary IgAN was 0.963,and 72 patients had high serum IgA/lymphocyte level and 72 patients had low serum IgA/lymphocyte level.Compared with the low IgA/lymphocyte group,the high IgA/lymphocyte group had lower serum complement C4 and 24 h urine protein quantitation,and higher serum IgA level(both P<0.05).There was no statistical difference in the new Oxford classification between different serum IgA/lymphocyte groups.The deposition rates of IgG and C3 in the high IgA/lymphocyte group was higher than that in the low IgA/lymphocyte group(both P<0.05),but there was no significant difference in the deposition rates of IgA and IgM.In both cases,vascular wall thickening and other lesions were the main causes of renal arteriole injury,accounting for about 50%.Ten patients with high IgA/lymphocyte level reached the end point,and eight patients with low IgA/lymphocyte level reached the end point.There was no statistical difference in the prognosis between the two groups.In the high IgA/lymphocyte group,the ineffective treatment,partial remission,and complete remission were found in 21,18,and 33 patients,while they were 28,

关 键 词：IGA肾病 免疫球蛋白A 淋巴细胞 生物标记物 

分 类 号：R692.31[医药卫生—泌尿科学]