特发性膜性肾病伴IgA沉积的临床及病理特征分析  

Analysis of clinical and pathological characteristics of idiopathic membranous nephropathy with IgA deposition

作　　者：赵凤丽 曹亚坤 张晓艳[3] Zhao Fengli;Cao Yakun;Zhang Xiaoyan(The First Clinical School of Changzhi Medical College,Changzhi,Shanxi 046000,China;Nephrology Department,Sinopharm Tongmei General Hospital,Datong,Shanxi 037000,China;Nephrology Department,Heping Hospital Affiliated to Changzhi Medical College,Changzhi,Shanxi 046000,China)

机构地区：[1]长治医学院第一临床学院,山西长治046000 [2]同药同煤总医院肾内科,山西大同037000 [3]长治医学院附属和平医院肾内科,山西长治046000

出　　处：《齐齐哈尔医学院学报》2024年第5期439-443,共5页Journal of Qiqihar Medical University

摘　　要：目的探讨特发性膜性肾病(IMN)伴免疫球蛋白IgA沉积的临床表现及病理特点,为早期判断IMN病变严重程度提供参考。方法选择2020年1月—2022年12月在本院就诊并经肾脏穿刺活检诊断为IMN的105例患者作为研究对象,按肾小球内有无IgA沉积分为IgA阳性组(22例)和IgA阴性组(83例)两组。比较两组的临床及病理资料,包括患者一般情况、临床表现、实验室检查指标、超声引导下肾穿刺活检病理资料等。结果105例IMN患者中男女之比约1.2︰1,平均发病年龄为(47.19±12.6)岁,临床首发症状以“水肿”为主,伴镜下血尿患者占比高,病理分期以膜性肾病Ⅱ期为主;IgA阴性组患者的24 h U-TP水平高于IgA阳性组,差异有统计学意义(P<0.05);IgA阳性组患者的补体C3指标均低于IgA阴性组,差异有统计学意义(P<0.05);IgA阳性组患者病理分期损伤较IgA阴性组更严重,差异有统计学意义(P<0.05);IgA阳性组患者的肾小球细胞内增生比例高于IgA阴性组,差异有统计学意义(P<0.05);IgA阴性组患者的肾小管萎缩、肾间质炎症细胞浸润比例高于IgA阳性组,差异有统计学意义(P<0.05);IgA阳性组患者的免疫荧光指标中PLA2R沉积比例低于IgA阴性组,差异有统计学意义(P<0.05)。结论105例IMN患者中男女之比约1.2︰1,平均发病年龄为(47.19±12.6)岁,临床首发症状以“水肿”为主,伴镜下血尿患者占比高,病理分期以膜性肾病Ⅱ期为主;IgA阴性组患者的24h U-TP水平高于IgA阳性组,差异有统计学意义(P<0.05);IgA阳性组患者的补体C3指标均低于IgA阴性组,差异有统计学意义(P<0.05);IgA阳性组患者病理分期损伤较IgA阴性组更严重,差异有统计学意义(P<0.05);IgA阳性组患者的肾小球细胞内增生比例高于IgA阴性组,差异有统计学意义(P<0.05);IgA阴性组患者的肾小管萎缩、肾间质炎症细胞浸润比例高于IgA阳性组,差异有统计学意义(P<0.05);IgA阳性组患者的免疫荧光指标Objective To study the clinical and pathological manifestation of idiopathic membranous nephropathy(IMN)with immunoglobulin IgA deposition,in order to provide references for early determining the severity of IMN.Methods From January 2020 to December 2022,105 patients who visited the hospital and were diagnosed as IMN by ultrasound-guided kidney biopsy were enrolled as study objects.According to the existence of immunoglobulin IgA deposition,they were classified into the IgA positive group(n=22)and the IgA negative group(n=83).Clinical and pathological data of the two groups were compared,including general condition,clinical manifestation,laboratory examination index,ultrasound renal puncture biopsy pathological data,and so on.Results The ratio of men to women in the 105 cases of IMN was about 1.2︰1,and the mean age of onset was(47.19±12.6)years.The first clinical symptom observed was edema,and a high proportion of patients exhibited microscopic hematuria.The majority of patients were classified as stage Ⅱ in terms of pathological stage.The 24h U-TP level of IgA negative group was higher than that of IgA positive group,and the difference was statistically significant(P<0.05).The complement C3 index of IgA positive group was lower than that of IgA negative group,and the difference was statistically significant(P<0.05).The pathological stage injury of the IgA positive group was more serious than that of the IgA negative group,and the difference was statistically significant(P<0.05).The proportion of glomerular hyperplasia in the IgA positive group was higher than that in the IgA negative group,and the difference was statistically significant(P<0.05).The proportion of kidney tubules atrophy,renal interstitium inflammatory cell infiltration in the IgA positive group was higher than that in the IgA negative group,and the difference was statistically significant(P<0.05).The proportion of Immunofluorescence index PLA2R deposition in the IgA positive group was significantly lower than that in the IgA negative group(P

关 键 词：特发性膜性肾病 IGA沉积 肾脏病理 

分 类 号：R692[医药卫生—泌尿科学]