IgA肾病患者血清IgM水平、肾小球系膜IgM沉积与临床病理特征的关系分析  

Correlation of serum IgM level and IgM deposition with clinicopathologic features in patients with IgA nephropathy

作　　者：夏虹[1] 张培培[1] 陈红波[1] 张春丽[2] 郑霖 方鸽 马红珍[1] XIA Hong;ZHANG Peipei;CHEN Hongbo;ZHANG Chunli;ZHENG Lin;FANG Ge;MA Hongzhen(不详;Department of Nephrology,the First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,China)

机构地区：[1]浙江中医药大学附属第一医院肾内科,杭州310006 [2]浙江中医药大学附属第一医院病理科,杭州310006 [3]浙江中医药大学第一临床医学院

出　　处：《浙江医学》2022年第2期169-174,179,共7页Zhejiang Medical Journal

基　　金：浙江省自然科学基金项目(LQ19H290003);浙江省中医药管理局科研基金项目(2017ZA053、2022ZB103);浙江中医药大学校级科研基金项目(2018ZG04)。

摘　　要：目的分析IgA肾病患者血清免疫球蛋白M(IgM)水平、肾小球系膜IgM沉积情况与临床病理特征的关系。方法回顾2012年7月至2020年6月在浙江中医药大学附属第一医院经肾穿刺活检病理确诊为IgA肾病的380例患者的临床资料。按肾穿刺时血清IgM水平中位数、肾小球系膜免疫荧光检测是否有IgM沉积分组,比较不同分组患者临床病理特征,分析血清IgM水平与IgM、IgA、补体3(C3)免疫荧光沉积强度的关系。结果(1)低IgM水平组男性及肾穿刺活检时合并有高血压患者的占比、收缩压、血IgA、血补体4(C4)、血LDL、血尿酸、血肌酐、尿素氮水平较高IgM水平组高(均P<0.05),血IgG水平较高IgM水平组低(P<0.05);血清IgM水平与肾穿刺活检时合并有高血压占比、收缩压、血IgA、血C4、LDL、血尿酸、血肌酐、尿素氮水平呈负相关(均P<0.05),与男性占比、血IgG水平呈正相关(均P<0.05)。IgM沉积组肉眼血尿发作患者占比高于IgM无沉积组(P<0.05),尿红细胞计数、血IgA低于IgM无沉积组(均P<0.05);IgM沉积与肉眼血尿发作、尿红细胞计数呈负相关(均P<0.05)。(2)低IgM水平组IgM沉积患者占比较高IgM水平组低(P<0.05);不同IgM水平及是否有IgM沉积两组间肾脏病理牛津分型(M1、E1、S1、T1~2、C1~2)及Lee氏分级(Ⅱ、Ⅲ、Ⅳ、V)占比,以及IgA、C3的免疫荧光沉积强度比较差异均无统计学意义(均P>0.05)。(3)IgM的血清水平与其沉积强度呈正相关(P<0.05)。结论根据血清IgM水平或是否有IgM沉积分组,IgA肾病患者临床特征存在明显差异,病理特征均无明显差异。血清IgM水平高低、IgM沉积与否与IgA肾病患者的临床特征有一定相关性。血清IgM水平与IgM沉积与否有一定相关性。Objective To determine the correlation of serum IgM and IgM deposition with clinicopathological features of patients with IgA nephropathy.Methods The clinicopathological data of 380 patients with IgA nephropathy confirmed by percutaneous renal biopsy in the First Affiliated Hospital of Zhejiang Chinese Medical University from July 2012 to June 2020 were analyzed.According to the median level of serum IgM or IgM deposition situation,the patients were grouped.The clinicopatholo-gical features of patients were compared among different groups.The correlation between serum IgM concentration and immunofluorescence deposit intensity of IgM,IgA and complement 3(C3)was analyzed.Results In patients with low serum IgM level,the proportion of patients with male gender and hypertension,the systolic blood pressure,serum IgA,serum complement 4(C4),low density lipoprotein,uric acid,serum creatinine and urea nitrogen were higher than those in patients with high serum IgM level(all P<0.05).Patients in low serum IgM level group had lower serum IgG(P<0.05).Serum IgM level was negatively correlated with the proportion of patients with hypertension,levels of systolic blood pressure,serum IgA,serum C4,low density lipoprotein,uric acid,serum creatinine and urea nitrogen during renal biopsy,and positively correlated with the proportion of male patients and the level of serum IgG.Proportion of gross hematuria attack in patients with IgM deposition was significantly higher than that in patients without IgM deposition(P<0.05).However,patients with IgM deposition had lower urine red blood cell count and serum IgA(P<0.05).IgM deposition was negatively correlated with gross hematuria attack and red blood cell count.Pathological analysis showed that the proportion of IgM deposition in low IgM level group was lower than that in high IgM level group(P<0.05).There was no significant difference in the proportion of different Oxford pathological classification(M1,E1,S1,T1-2,C1-2)and Lee grades(Ⅱ,III,IV,V)and the intensity of immunofluorescence dep

关 键 词：免疫球蛋白M IGA肾病 病理学 

分 类 号：R692.31[医药卫生—泌尿科学]