原发性IgA肾病与非IgA系膜增生性肾小球肾炎的临床病理分析

目的 比较原发性IgA肾病与非IgA系膜增生性肾小球肾炎（non-IgA mesangial proliferative glomerulonephritis,non-IgA MsPGN）的临床及肾脏病理改变特点.方法 选择我科经肾活检确诊的原发性IgA肾病患者（A组）和non-IgA MsPGN患者（B组）进行临床与病理资料对比分析.结果 A、B组的性别、前驱上呼吸道感染诱因、起病时伴发高血压、镜下血尿、血肌酐无统计学差异（P＞0.05）.B组较A组起病年龄小,起病时伴发肉眼血尿比率低,肾病综合征发生率高,血IgG水平低,差异均有统计学意义（P＜0.05）.A组肾小球、肾小管间质、肾小动脉病理改变发生率高于B组（P＜0.05）,IgM、C3沉积、系膜区电子致密物沉积、大块状致密物、足细胞微绒毛化、肾小球基底膜分层发生率均较B组高（P＜0.01）.结论 IgA肾病与non-IgA MsPGN在临床表现、病理改变上存在明显差异,IgA肾病较non-IgA MsPGN病理损伤重.

Comparative analysis of clinical and pathological characteristics between IgA nephropathy and non-IgA mesangial proliferative glomerulonephritis

Objective To analyze the clinical and pathological characteristics of IgA nephropathy and non-IgA mesangial proliferative glomerulonephritis （non-IgA MsPGN）. Methods Reviewing the clinicopathological and laboratory index of patients with [gA nephropathy and non-IgA MsPGN di agnosed by renal biopsy in Renmin Hospital of Wuhan University from October 2007 to July 2011 I. Results The clinical manifestations, including sex ratio, course of disease, upper respiratory infection, hypertension , microscopic hematuria, serum C3. IgA, IgM and creatinine were similar in patients with IgA nephropathy and non-IgA MsPGN（P〈0. 05）. While the age.gross hematuria and serum IgG were significantly higher in IgA nephropathy than non-IgA MsPGN（P〈0. 01 ）. The occurrence rate of nephrotic syndrome was significantly higher in non-IgA MsPGN as compared with IgA nephropathy（P〈 0. 01 ）. Light microscope examination, such as Segmental sclerosis, Global sclerosis, Moderate to severe Mesangial proliferative, crescent, tubular atrophy, interstitial fibrosis, small artery injury were significantly higher in IgA nephropathy than non-IgA MsPGN （P〈0. 05）. No significant difference was found in the depositions of IgG,Clq between two groups（P〉0. 05） ,while the depositions of IgM.C3 were significantly higher in IgA nephropathy than non-IgA MsPGN（P〈0. 01 ）. Electron microscope examination, such as podocyte microvilli, stratification of glomerular basement membrane were significantly higher in IgA nephropathy than non-IgA MsPGN（P〈0. 01 ）. Conclusions Significant clinico pathological differences were found between IgA nephropathy and non-IgA MsPGN and the pathological changes were markedly serious in IgA nephropathy than non-IgA MsPGN.