狼疮性肾炎不同中医证型免疫荧光病理的差异探讨

【目的】探讨狼疮性肾炎(LN)不同中医证型免疫荧光病理检查的差异。【方法】回顾性研究已行肾组织活检的LN患者116例,将所有患者按中医辨证分为热毒炽盛型、肝肾阴虚型、气阴两虚型、脾肾两虚型4型,记录免疫荧光病理结果,分析其不同中医证型之间免疫荧光的差异。【结果】(1)中医证型分布:116例LN患者中,脾肾两虚型59例,热毒炽盛型30例,肝肾阴虚型14例,气阴两虚型13例。(2)LN患者的Ig A、Ig G、Ig M、C3、Fi 5种荧光抗体的阳性率比较,差异有统计学意义(P0.05),其中以Ig A、C3为主,Fi最低。(3)不同中医证型的"满堂亮"现象(免疫荧光染色在5种抗体中同时出现阳性者)比较,差异有统计学意义(P0.05),热毒炽盛型所占比例最高。(4)不同中医证型的免疫荧光阳性率比较,差异无统计学意义(P0.05)。【结论】LN患者免疫复合物沉积以Ig A、C3为主,"满堂亮"现象在热毒炽盛型患者中最多见,但难以从免疫荧光结果来分析不同中医证型的差异。

Clinicopathalogical Differences of Immunofluorescent Staining Results in Lupus Nephritis Patients with Various Syndrome Patterns

Objective To discuss the differences of immunofluorescence pathological test results in four types of syndromes for lupus nephritis(LN) patients. Methods A retrospective study was carried out in 116 LN patients who had performed renal biopsy. The patients were differentiated into four syndrome patterns of excessive heat-toxicity, liver-kidney yin deficiency, qi-yin deficiency, and spleen-kidney deficiency. The results of immunofluorescence pathological tests were recorded for the analysis of the differences among the four patterns. Results (1)Of 116 LN patients, 59 were classified into spleen-kidney deficiency, 30 into excessive heat-toxicity, 14 into liver-kidney yin deficiency, and 13 into qi-yin deficiency. (2)The positive expression rate of IgA, IgG, IgM, C3, and Fi fluorescen ce antibody differed in the 4 syndrome patterns of LN patients(P<0.05), IgA and C3 had higher positive expression rate, while Fi had the lowest expression rate. (3)The percentage of“full-house” immunofluorescence staining(5 kinds of antibodies simultaneously showing positive immunofluorescence staining) differed in the 4 syndrome patterns of LN patients(P<0.05), and excessive heat-toxicity syndrome had the highest percentage. (4)The differences of positive rate of immunofluorescence staining were insignificant in the 4 syndrome patterns of LN patients(P>0.05). Conclusion The immune complex deposition in LN patients is dominated by IgA and C3 antibodies deposition, and the“full-house” immunofluorescence staining is commonly seen in the syndrome of excessive heat-toxin type. But the results of immunofluorescence pathological tests can not be used as the evidence to tell the differences in the 4 syndrome patterns of LN patients.