发病前急性感染对成人IgA肾病患者血清及肾组织免疫球蛋白、补体水平的影响  

Influence of acute infection before onset on the levels of immunoglobulins and complements in serum and renal tissue of adult patients with IgA nephropathy

作　　者：陈开浪[1] 林松[2] 吴东明 苏汝开[4] 陈元椿[5] Chen Kailang;Lin Song;Wu Dongming;Su Rukai;Chen Yuanchun(Department of Nephrology and Rheumatology,Haikou People's Hospital,Haikou 570208,China;Department of Pathology,the First Affiliated Hospital of Hainan Medical College,Haikou 570103,China;Department of Nephrology,Hainan Hospital of Traditional Chinese Medicine,Haikou 570203,China;Department of Infection,Haikou People's Hospital,Haikou 570208,China;Department of General Internal Medicine,Hainan Cadre Sanatorium,Haikou 571199,China)

机构地区：[1]海口市人民医院肾病风湿科,海口570208 [2]海南医学院第一附属医院病理科,海口570103 [3]海南省中医院,海口570203 [4]海口市人民医院,海口570208 [5]海南省干部疗养院内一科,海口571199

出　　处：《中华临床医师杂志（电子版）》2022年第2期157-163,共7页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的分析发病前急性感染对成人免疫球蛋白A(IgA)肾病患者血清及肾组织免疫球蛋白(Ig)、补体(C)水平的影响,为明确感染因素在IgA肾病发生和发展的作用提供依据。方法选取2014年10月至2018年2月海口市人民医院风湿肾病科收治的60例发病前急性感染成人IgA肾病患者作为研究组,选取同期60例发病前未出现急性感染成人IgA肾病患者作为对照组,观察对比2组患者的一般资料、血清Ig、C水平及肾组织Ig、C沉积强度。结果在研究组中,43例(71.67%)患者于发病前发生急性上呼吸道感染,11例(18.33%)患者于发病前发生急性肺部感染,6例(10%)于发病前发生急性消化道感染。研究组患者的24 h尿蛋白定量、血清IgA、IgG水平分别为(2.82±1.33)g/d、(2.87±1.06)g/L、(8.14±3.04)g/L,均明显高于对照组,差异有统计学意义(P<0.05)。研究组患者肾组织的IgA、IgG、C3、C4、C1q沉积强度均高于对照组,差异均有统计学意义(P<0.05)。结论发病前具有急性感染史的IgA肾病患者的蛋白尿症状更加严重,血清Ig水平和肾组织Ig、C沉积强度更高,其预后情况可能更差,临床医生应对此类患者给予充分重视和及时有效的干预治疗。Objective To analyze the influence of acute infection before onset on the levels of immunoglobulins(Igs)and complements(Cs)in serum and renal tissue of adult patients with IgA nephropathy,to provide evidence for the role of infection factors in the occurrence and progression of IgA nephropathy.Methods Sixty adult IgA nephropathy patients with acute infection before onset from October 2014 to February 2018 at the Department of Rheumatic Nephropathy of Haikou People's Hospital were selected as a study group,and 60 adult IgA nephropathy patients without acute infection before onset were selected as a control group.The general data,the levels of serum Igs and Cs,and the deposition intensity of Igs and Cs in renal tissue were compared between the two groups.Results In the study group,43 cases(71.67%)had acute upper respiratory tract infection before onset,11(18.33%)had acute pulmonary infection before onset,and 6(10%)had acute digestive tract infection before onset.The 24-hour urinary protein quantity,the levels of serum IgAand IgG of the patients in the study group were(2.82±1.33)g/d,(2.87±1.06)g/L,and(8.14±3.04)g/L,respectively,which were higher than those of the control group(P<0.05).The deposition intensity of IgA,IgG,C3,C4,and C1q in the renal tissue of the study group were significantly higher than those of the control group(P<0.05).Conclusion The proteinuria symptoms of IgA nephropathy patients with a history of acute infection before onset are more serious,the levels of serum Ig and the deposition intensity of Igs and Cs in renal tissue are higher,and the prognosis may be worse.Clinicians should give full attention and timely and effective intervention to these patients.

关 键 词：免疫球蛋白A肾病 感染 免疫球蛋白 补体 

分 类 号：R692[医药卫生—泌尿科学]