检测血、尿IgG4在特发性膜性肾病中的临床意义

目的： 探讨IgG4/IgG比值作为反映特发性膜性肾病病情活动和治疗预后的生物学指标的可能性。方法：收集40例特发性膜性肾病、16例微小病变和10例局灶节段性肾小球硬化患者肾活检当天的血和尿标本，以32例健康志愿者的血和尿作为对照组。IgG和IgG4的测定均采用夹心酶联免疫吸附法，IgG4/IgG由IgG4的浓度除以IgG的浓度得出。结果：特发性膜性肾病患者血和尿IgG4/IgG比值分别显著高于微小病变和局灶节段性肾小球硬化患者（P均<0.05）；特发性膜性肾病中，肾病综合征患者血和尿IgG4/IgG均高于非肾病水平蛋白尿患者（P=0.063，P<0.05），缓解后患者血和尿IgG4/IgG均较治疗前显著降低(P<0.05），而未缓解患者与治疗前比较，该比值无显著下降，甚至反而升高。24例随访患者中，2年随访期内复发患者的尿IgG4/IgG显著高于未复发者(P<0.05)，肾活检时尿IgG4/IgG≥9%的患者有较高的复发趋势(P=0.071)。结论： IgG4/IgG比值可能有望作为反映特发性膜性肾病病情活动和治疗预后的生物学指标之一。

Clinical significance of detection of plasma and urine IgG4 in idiopathic membranous nephropathy

Objective:To investigate the possibility of IgG4/IgG as one of biomarkers to reflect disease activity and the relapse of idiopathic membranous nephropathy (IMN). Methods: Plasma and urine samples were obtained from patients with IMN (Twenty-four patients had follow-up data),minimal change disease (MCD) and focal segmental glomerulosclerosis(FSGS) before immunosuppressive therapy. Concentrations of plasma and urine IgG4 and total IgG were detected by sandwich ELISA. The ratio of IgG4/IgG was calculated as th...