轻链型淀粉样变肾病的临床特征及筛查指标研究  

Clinical characteristics and screening indexes of light chain amyloidosis nephropathy

作　　者：范亚娟 吴歌[1] 张珊珊[1] Fan Yajuan;Wu Ge;Zhang Shanshan(Department of Nephrology,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肾内科,450052

出　　处：《中国实用医刊》2019年第23期6-10,共5页Chinese Journal of Practical Medicine

基　　金：河南省医学科技攻关项目(SBGJ2018035)。

摘　　要：目的分析轻链型淀粉样变肾病(AL肾病)的临床特征并探索其实验室筛查指标。方法选取2014年10月至2017年10月在郑州大学第一附属医院肾内科经肾活检确诊的AL肾病患者119例,依据肾损害分期分为蛋白尿组(30例)、肾病综合征组(61例)和肾功能不全组(28例),回顾性分析其临床资料。结果不同分期肾损害AL肾病患者的血压、血红蛋白、球蛋白、血沉、钙磷、血Kappa链、免疫球蛋白IgG比较差异有统计学意义(P<0.05),联合检测尿本周氏蛋白及血免疫固定电泳能提高M蛋白的检出率。结论以肾病综合征为表现的AL肾病患者常表现为较低的血免疫球蛋白IgG及Kappa链。贫血加重、球蛋白高、血沉增快可能是AL肾病肾损害进展的风险因素。联合检测血免疫固定电泳及尿本周氏蛋白有助于筛查AL肾病,而其确诊仍依赖于肾活检。Objective To study the clinical features of light chain amyloidosis nephropathy(AL-nephropathy),and investigate its laboratory screening indicators.Methods A total of 119 patients with AL-nephropathy confirmed by renal biopsy in Department of Nephrology,the First Affiliated Hospital of Zhengzhou University from October 2014 to October 2017 were selected.According to the kidney damage staging,the patients were divided into proteinuria group(n=30),nephrotic syndrome group(n=61)and renal insufficiency group(n=28).The clinical data of the patients were retrospectively analyzed.Results There were statistically significant differences in blood pressure,hemoglobin,globulin,erythrocyte sedimentation rate,calcium and phosphorus,blood Kappa chain,immunoglobulin IgG in patients with AL-nephropathy with renal damage at different stages(P<0.05).Combined detection of urinary Bence-Jones protein and blood immunofixation electrophoresis could improve the detection rate of M protein.Conclusions Patients with AL-nephropathy characterized by nephrotic syndrome often present with low blood immunoglobulin IgG and Kappa chains.Increased anemia,high globulin and rapid erythrocyte sedimentation rate may be risk factors for the progression of renal impairment in AL-nephropathy.A combination of blood immunofixation electrophoresis and urinary Bence-Jones protein is helpful in screening AL-nephropathy.However,the definite diagnosis still depends on renal biopsy.

关 键 词：轻链型淀粉样变 肾病 临床特征 筛查 

分 类 号：R692[医药卫生—泌尿科学]