IgA肾病的临床特征分析

IgA肾病是原发性肾小球肾炎中最常见的一种独立性疾病,占原发性肾小球疾病的26％～34％,是导致终末期肾功能衰竭的主要原因之一。为了解IgA肾病的临床特征,以提高临床诊断、治疗水平及判断预后,作者对近年来收治的40例IgA肾病的临床、病理和免疫荧光资料进行分析,结果报道如下。     

儿童IgA肾病血清PDGF-BB测定的临床意义

目的：探讨血清血小板源生长因子-BB（platelet derived growth factor-BB,PDGF-BB）检测在IgA肾病患儿中的意义。方法：应用酶联免疫吸附法（ELISA）定量测定30例IgA肾病患儿,21例非IgA肾病患儿（对照）,15例健康儿童（对照）PDGF-BB水平并进行比较。结果：对照组PDGF-BB水平为（447.38±186.38）ng/L,对照组PDGF-BB水平为（247.35±55.79）ng/L,IgA肾病组血清PDGF-BB水平为（869.16±200.73）ng/L,显著高于对照组和对照组（均为P〈0.05）。另外血清PDGF-BB水平与24 h尿蛋白定量显著相关（r=0.673 2,P〈0.05）。结论：血清PDGF-BB可以作为IgA肾病病变程度及进展情况的临床检测指标之一。     

盐酸青藤碱治疗IgA肾病的临床观察

IgA肾病（Berger病）目前已成为全球范围内最为常见的肾小球疾病之一。IgA肾病是慢性进展性疾病，约有40％的IgA肾病患者可能会发展为终末期肾病。目前针对该疾病的特异性治疗方法尚欠缺。临床上对于24小时尿蛋白〉1g的患者多应用激素、环磷酰胺、雷公藤多甙等药物治疗，但是因为其不良反应的存在，临床应用受到限制，常不能被患者接受。盐酸青藤碱具有抗炎、免疫抑制、镇痛、降压、抗心律失常等药理作用，不良反应少，使用安全，主要用于治疗类风湿性关节炎等各种风湿性疾病，我科应用盐酸青藤碱治疗IgA肾病取得良好疗效，现报告如下。     

IL-12和IgG在狼疮肾炎患者中表达的意义

目的：探讨狼疮肾炎患者白细胞介素－12（IL－12）和免疫球蛋白（Ig）G水平表达的意义。方法：采用酶联免疫吸附法（ELISA）检测39例疮肾炎患者及11名正常人的外周血单个核细胞（PBMC）培养上清液中IL－12和IgG水平，并作比较。结果：狼疮肾炎活动期、静止期IL－12和IgG水平较正常对照均明显升高（P＜0.01），并且在活动狼疮肾炎IL－12与IgG水平呈正相关。结论：狼疮肾炎PBMC异常分泌IL－12、IgG，IL－12通过促进自身抗体分泌参与狼疮肾炎发病，IL－12水平可反映狼疮肾炎活动程度。     

IgA肾病胰岛素抵抗的临床研究

慢性肾脏病(CKD)是一个全球范围内的公共卫生问题,IgA肾病是最常见的原发性肾小球疾病,影响到1%以上的普通人群,也是我国最常见的CKD和慢性肾功能衰竭的首要原发病。胰岛素抵抗(IR)与心血管事件发生关系密切,而心血管疾病(CVD)是CKD患者最常见的并发症和最主要的死亡原因。有关     

乙型肝炎患者血清学标志物检测结果分析

目的探讨HBV血清学标记的表现模式。方法酶联免疫吸附法检测。结果本组血清病毒学标记分为10种感染期模式。主要以HBsAg、HBcAb、HBeAg即“大三阳”和HBsAg、HBcAb、HBeAb即“小三阳”模式为主，占全部病例的68．19％。结论HBV血清免疫学标记的模式较为复杂，除检验误差外，产生少见模式的主要原因有低滴度HBcAb、低滴度HBeAb等。     

IgA肾病的治疗进展

原发性IgA肾病(IgA nephropathy,IgAN)是一种免疫复合物介导的肾小球肾炎,以肾小球系膜IgA沉积为主要特征.IgAN是最常见的原发型肾小球疾病,它是各年龄段人终末期肾病的重要病因.     

两种不同免疫检测技术在乙肝病毒血清检验中的价值分析

目的 探讨在乙肝病毒血清学检测中予酶联免疫吸附法(enzyme-linked im-munosorbent assay, ELISA与电化学发光法(electrochemiluminescent immunoassay, ECLIA)检测的价值。方法 选取2020年1—12月于泰兴市中医院检测的疑似乙肝患者200例为研究对象,均采血分离血清后予以ELISA、ECLIA检验,以临床综合诊断结果为金标准,评估两种检测方法对诊断乙肝的价值,并分析ELISA、ECLIA检验对乙肝病毒血清学指标的检测情况。结果 ECLIA检测与金标准一致性较好(Kappa=0.93);ELISA检测与金标准一致性较好(Kappa=0.85)。ECLIA检测诊断乙肝的准确率、灵敏度、特异度分别为97.50%、98.09%、95.35%,与ELISA的95.50%、95.54%、95.35%比较,差异无统计学意义(χ²=2.250、2.250、0.001,P>0.05)。ECLIA对HBsAg、HBeAg、HBeAb的阳性检出率分别为36.94%、70.06%、32.48%,高于ELIS...     

IgA肾病的预后及其影响因素

IgA肾病在全世界,特别在亚洲国家是最常见的原发性肾小球肾炎,由于在早期的报告中,多数患者肾功能正常,故曾被认为是反复发作的良性血尿综合征[1]。随后在长期的研究观察后,发现其预后变化相当大,20%~50%的患者在诊断后20年进展到慢性肾功能衰竭(CRF),68%肾功能稳定[1],仅5%~10     

Significance of serum IgA levels and serum IgA/C3 ratio in diagnostic analysis of patients with IgA nephropathy

Diagnostic analysis of clinical markers including serum IgA levels and serum IgA/C3 ratio in patients with IgA nephropathy is described. One hundred patients with IgA nephropathy (IgA nephropathy group) and 100 patients with other primary glomerular diseases (non-IgA nephropathy group) were examined. The analysis was performed to distinguish between these two groups using four clinical markers: 1) more than five red blood cells in urinary sediments, 2) persistent proteinuria (urinary protein of more than 0.3 g/day), 3) serum IgA levels of more than 315 mg/dl, and 4) a serum IgA/C3 ratio of more than 3.01. Patients with three or four clinical markers were easily diagnosed as having IgA nephropathy in this study. Furthermore, there was a significant difference in these clinical markers between the good prognosis and relatively good prognosis groups (Groups I and II) and the relatively poor prognosis and poor prognosis groups (Groups III and IV) of IgA nephropathy patients. It appears that the presence of microscopic hematuria and/or persistent proteinuria, high serum IgA levels, and the serum IgA/C3 ratio are useful for distinguishing IgA nephropathy from other primary renal diseases. It is postulated that these clinical markers are also useful for diagnosis of IgA nephropathy without renal biopsy.     

血清IgA及IgA／C3比值在IgA肾病诊断中的价值

IgA肾病(IgA nephropathy,IgAN)是我国最常见的原发性肾小球肾炎,但至今其确切发病机制仍不明确.免疫反应和补体系统可能在IgAN的发生、发展中起重要作用,9%～70%的IgAN患者血清IgA升高[1],其血清C3水平是否下降仍有争议.     

血清IgA、IgA/C3比值在IgA肾病的诊断价值

目的探讨体检发现的IgA肾病(IgAN)患者血清IgA、IgA/C3比值在病理损伤评估和诊断预测方面的价值。方法 2005年8月至2010年12月因体检异常来中山医院就诊并经肾活检确诊为IgAN患者239例,回顾性分析这些患者的临床病理资料。所有患者都检测血清IgA、C3水平,病理学分级参照Lee′s分级标准。结果 IgAN患者血清IgA、IgA/C3水平较其他非IgA肾脏病理类型患者高;IgA、IgA/C3与IgAN病理损伤程度无相关性(P>0.05),二者的ROC曲线下面积分别为0.597、0.611。结论血清IgA、IgA/C3比值在IgAN患者明显升高,但二者水平与病理病变无相关性,对体检发现的IgAN诊断预测价值较低。     

IgA肾病合并急性间质性肾炎2例报告

正急性间质性肾炎(AIN)是导致急性肾损伤(AKI)的重要原因之一。AIN的主要病理表现为肾间质炎细胞浸润,通常不伴肾小球病变。在慢性肾小球肾炎基础上发生的AIN的临床病理表现与单纯AIN、慢性肾小球肾炎继发间质损害有一定区别。本科室近期连续诊治2例IgA肾病合并急性间质性肾炎患者,现报告如下。     

IgA肾病患者肾间质容量和尿表皮生长因子测定的意义

目的探讨尿表皮生长因子含量与IgA肾病(IgAN)患者肾小球和肾间质病理改变严重程度之间的关系。方法对70例有不同程度肾小管、肾间质损伤的IgAN患者采用放射免疫分析技术(RIA)测定尿表皮生长因子浓度;采用CMIAS2000多功能真彩色病理图像分析系统,进行测量肾小球的包曼囊、肾小管及血管面积总和以及所采集图像的总皮质面积。根据WHO诊断标准,将IgA 70例患者分为轻度病变组、中度病变组和重度病变组。另外,对照组为肾小球微小病变患者。结果尿表皮生长因子浓度:对照组为(56.8±6.7)μg/L,轻度病变组为(97.6±15.1)μg/L,中度病变组为(36.1±6.9)μg/L,重度病变组为(6.7±2.6)μg/L。4组之间的差异均有统计学意义。肾间质容量:对照组为(18.6±1.8)%,轻度病变组为(23.0±2.9)%,中度病变组为(36.2±6.7)%,重度病变组为(55.0±6.5)%。4组患者之间的差异均有统计学意义。结论肾间质容量反映肾间质小管的损害程度。尿表皮生长因子与肾小管、肾间质损伤有密切关系,可作为IgAN病变进展的标志。     

IgA肾病与过敏性紫癜性肾炎的临床和病理对比分析

目的对比研究有新月体形成(<50%)的IgAN肾病(IgAN)和过敏性紫癜性肾炎(HSPN)在临床及肾脏病理改变上的异同,探讨两者的关系。方法对经肾活检证实的病理上有<50%新月体形成的25例IgAN及23例HSPN成人(>18岁)进行临床及病理对比分析。结果IgAN和HSPN临床表现相似,高血压、血尿、蛋白尿、尿NAG酶升高等发生率差异均无显著性(P>0.05);IgAN肾功能损害程度较重,两者的血肌酐水平差异有显著性(P<0.05);IgAN和HSPN肾脏的组织病理检查,节段新月体形成率和球囊粘连、内皮增生、节段硬化等发生率差异均无显著性(P>0.05),而袢坏死、球性硬化、肾间质纤维化、肾小管萎缩发生率差异均有显著性(P<0.05);两组免疫病理均以IgA在系膜区沉积为主(伴或不伴血管袢的沉积),沉积差异无显著性(P>0.05)。结论IgAN与HSPN两者在高血压、血尿、蛋白尿发生率等临床表现差异无显著性,但IgAN肾功能减退明显,肾组织发生球性硬化、间质纤维化、小管萎缩等慢性化病变较重。     

Isolation of IgA1 from human serum by affinity chromatography using an immobilized extract of the albumin gland of Helix pomatia

SUMMARY. An extract of the albumin gland of Helix pomatia was linked to Sepharose-4B and used to prepare IgA from group O human serum; immunoelectrophoresis showed that the preparation was free of IgG and IgM. From studies with specific IgA subclass antisera and by comparison with the activity of jacalin-produced material the Helix pomatia extract was found to be IgA1 specific. The preparation had red cell anti-A,B specificity and was suitable for standardizing and controlling anti-human IgA reagents. Preparations using six different carbohydrates as eluants inhibited the agglutination reaction between anti-human IgA and IgA-coated red cells to varying degrees. The pattern of reactions suggested that N -acetyl glucosamine was the IgA binding site for Helix pomatia ; this differed from its blood group A determinant ( N -acetyl galactosamine) which was the same as that for the IgA1 reactive component of jacalin.     

Increased sialylation of polymeric lambda-IgA1 in patients with IgA nephropathy

The mechanism of mesangial IgA deposition is poorly understood in IgA nephropathy (IgAN). Abnormal glycosylation of carbohydrate moieties in the hinge region of the IgA molecule has recently attracted much attention. In this report, we studied galactosylation and sialylation profiles in kappa- and lambda-IgA1 from patients with IgAN. Total serum IgA1 was isolated from patients with IgAN or healthy controls by jacalin-affinity chromatography. Six fractions of molecular weight (MW) 50-1,000 kDa were separated by fast protein liquid chromatography (FPLC). Four lectin-binding assays were used to study the sialylation and the presence of terminal galactose or N-acetylgalactosamine (GalNAc) in the O-linked carbohydrate moieties of kappa- or lambda-IgA1. Maackia amurensis agglutinin (MAA) and Sambucus nigra agglutinin (SNA) lectin recognize alpha(2,3)- and alpha(2,6)-linked sialic acid, respectively. Peanut agglutinin (PNA) and Helix aspersa (HA) lectin recognize terminal galactose and GalNAc, respectively. Reduced HA was demonstrated in macromolecular kappa or lambda-IgA1 (300-825 kDa) isolated from patients with IgAN (P < 0.05 compared with healthy controls). Lambda- but not kappa-IgA1 from patients with IgAN bound less to PNA (P < 0.05). The alpha(2,3)-linked sialic acid content in lambda- but not kappa-IgA1 of MW 150-610 kDa from patients was higher than that of controls (P < 0.005). The alpha(2,6)-linked sialic acid content in lambda-IgA1 (300-825 kDa) and kappa-IgA1 (150-610 kDa) from patients was also higher than that of controls. This unusual glycosylation and sialylation pattern of the lambda-IgA1 may have important implications for the pathogenesis of IgAN, as both the masking effect of sialic acid on galactose and the reduced galactosylation will hinder the clearance of macromolecular lambda-IgA1 by asialoglycoprotein receptor of hepatocytes. The negative charge from sialic acid may also favor mesangial deposition of macromolecular lambda-IgA1 in IgAN.     

Mesangial medium with IgA1 from IgA nephropathy inhibits nephrin expression in mouse podocytes

Background  IgA nephropathy (IgAN) is characterized by mesangial deposition of polymeric IgA1, and podocyte injury plays an important role in glomerulosclerosis of the disease. Our previous study indicated that medium of mesangial cells co-incubated with aggregated IgA1 (aIgA1), isolated from IgAN patients, down-regulated nephrin expression. Yet the mechanism remains unclear.
Materials and methods  Podocytes were incubated with a medium of mesangial cells co-incubated with aIgA1, which was isolated from IgAN patients, and enalaprilat (10⁻⁵ M), valsartan (10⁻⁵ M) and anti-mouse tumour necrosis factor-α antibody (50 ng mL⁻¹) separately. Nephrin expression in podocytes was measured by real-time polymerase chain reaction and Western blot analysis.
Results  The level of angiotensinogen and angiotensin-converting enzyme mRNAs in podocytes, as well as angiotensin, was also increased by a medium of mesangial cells co-incubated with aIgA1 from IgAN patients( P  <   0·05). Enalaprilat or valsartan partly improved nephrin expression when compared with that by podocytes exposed to the mesangial medium ( P  <   0·05), while the nephrin expression of podocytes with enalaprilat or valsartan was lower than that of podocytes exposed to medium of mesangial cells stimulated by aIgA1 from healthy control ( P  <   0·05). However, anti-mouse tumour necrosis factor-α antibody did not show any improvement in nephrin expression.
Conclusion  Our findings implicate that local renin angiotensin system activation in podocytes is partly involved in down-regulation of nephrin by mesangial medium in IgA nephropathy.     

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

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。