血清主导的及肾小球沉积的IgG亚型和补体分子对肾小球疾病作用的研究进展  

Research advances on the effects of serum-dominated and glomerular deposited IgG subclasses and complement molecules on glomerular diseases

作　　者：李琪[1] 王悦[1] Li Qi;Wang Yue(Department of Nephrology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院肾内科,北京100191

出　　处：《临床肾脏病杂志》2024年第7期598-602,共5页Journal Of Clinical Nephrology

基　　金：国家自然科学基金(82070736,81870488)。

摘　　要：肾小球疾病患者血清主导的、肾小球沉积的IgG亚型和补体分子对疾病发生发展及其预后发挥重大作用。系统性红斑狼疮引起的狼疮肾炎患者,血清和肾小球中的IgG亚型以IgG1和IgG3为主,肾小球常见补体C1q和C3沉积,补体活化以经典途径为主,起病较急,病情较重,预后较差,补体C3、C4降低均反映疾病活动;原发性膜性肾病患者,血清和肾小球中的IgG亚型以IgG4为主,肾小球常见补体C3、C4d沉积,补体活化以凝集素途径为主,起病较慢,病情较轻,预后较好,血清特异性抗磷脂酶A2受体抗体滴度升高反映病情活动。其他肾小球疾病如IgA肾病、抗中性粒细胞胞浆抗体相关小血管炎肾损伤等,血清及肾小球IgG亚型、补体分子也有较多研究报道,而感染性、代谢性、肿瘤相关肾小球疾病,相关研究报道较少,对疾病的诊断、鉴别诊断以及预后的评估价值有待进一步探讨。IgG subclasses and complement molecules of sera-dominant and depositing in glomeruli play major roles in development and prognosis in patients of glomerular diseases.In patients of lupus nephritis(LN)due to systemic lupus erythematosus(SLE),IgG subclasses depositing in sera and glomeruli are predominantly IgG1 and IgG3.And C1q and C3 deposits in glomeruli may be observed.Complement activation is predominant in classical pathway with an acute onset.A more severe state de-notes a worse prognosis.A lower serum level of C3/C4 reflect disease activities.In patients of primary membranous nephropathy(PMN),IgG4 is a predominant IgG subclass deposited in sera and glomeruli.De-position of complement C3/C4d is common in glomeruli.And complement activation is dominated by lactin pathway with a slower onset,a milder status and a better prognosis and an elevation of specific anti-PLA2R antibodies in sera reflects disease activity.In IgA nephropathy and ANCA-associated vasculitis kidney injury,IgG subclasses and complement molecules in sera and glomerulus have been reported.Whereas infectious,metabolic and tumor-associated glomerular diseases are less thoroughly studied,the values of diagnosis,differential diagnosis and prognostic assessment should be further explored.

关 键 词：肾小球疾病 血清 肾组织 IGG亚型 补体 

分 类 号：R692[医药卫生—泌尿科学]