成人原发性IgA肾病患者肾脏IgM沉积与临床及病理的关系

目的 探讨成人原发性IgA肾病(IgAN)患者肾脏IgM沉积与临床及病理的关系.方法 收集经皮肾活检病理证实为成人原发性IgAN的147例患者,分为IgM阴性组和IgM沉积组,对两组的临床表现、实验室检查及肾脏病理进行比较分析.结果 ① 与IgM阴性组相比,IgM沉积组患者肾病综合征的例数、24 h尿蛋白定量、24 h尿蛋白/肌酐、尿总蛋白及血尿素氮均明显增加,血白蛋白及肾小球滤过率(eGFR)、血IgG明显下降,慢性肾脏病(CKD)分期更重,尿转铁蛋白、尿白蛋白、尿IgG及尿N-乙酰β-D-氨基葡萄糖苷酶(NAG)明显增加,差异有统计学意义(P<0.05);② IgM沉积组Lee氏分级Ⅳ级比例增加,但两组间差异无统计学意义;牛津分类中两组间比较,M、E、S差异无统计学意义,T分类中IgM沉积组病理损害更重,且差异有统计学意义(P<0.05);用Katafuchi半定量分析,结果显示IgM沉积组的肾脏病理总积分、肾小管间质积分与IgM阴性组相比差异有统计学意义(P<0.05).结论 肾脏IgM沉积的成人原发性IgAN患者的尿蛋白程度更高,临床表现更重,肾小球损伤明显,病理表现中肾小管间质病变及肾脏总的病理损害更为明显.

Relationship between renal IgM deposition and clinicopathologicalfeatures of adult patients with primary IgA nephropathy

Objective To explore the relationship between renal IgM deposition and clinicopathological features of adult patients with primary IgA nephropathy (IgAN).Methods A total of 147 adult patients diagnosed to have primary IgAN by kidney biopsy were divided into two groups by renal IgM deposition: IgM negative group and IgM deposition group.The clinical manifestations, laboratory tests and renal pathological features of two groups were retrospectively investigated and compared.Results ① Compared to IgM negative group, IgM deposition group had a significantly increase in the number of patients with nephrotic syndrome, proteinuria in 24 h,urinary protein:creati-nine ratio in 24 h, urine total protein, blood urea nitrogen, urinary transferrin, urinary albumin, urinary IgG and urinary N-Acetyl-β-D-glucosaminidase (NAG) (P<0.05).Besides, IgM deposition group was found a significantly lower serum albumin, estimated glomerular filtration rate (eGFR), serum IgG and worse stages of chronic kidney disease (CKD) than IgM negative group.② The percentage of patients with Lee grading Ⅳ in IgM deposition group increased, but there was no significant difference between the two groups.In the Oxford classification of IgAN, no significant difference was found in the severity scores of M, E and S between the two groups while the IgM deposition group was found a higher severity scores of T than the IgM negative group (P<0.05).According to the Katafuchi semiquantitative critiria of IgAN, The difference in the total pathological score and tubulo-interstitial score between IgM negative group and IgM deposition group was significant (P<0.05).Conclusion Adult primary IgAN patients with renal IgM deposition are with greater urinary protein excretion, worse clinical manifestations, more obvious glomerular injury, worse renal tubulointerstitial lesions and renal pathological damage than those of IgM negative group.