IgA肾病患者肾小球内纤维蛋白原沉积的意义

目的探讨IgA肾病患者肾小球内纤维蛋白原（Fg）沉积的意义。方法将103例IgA肾病患者按照肾活检免疫荧光结果分为无№沉积组和有Fg沉积组，对两组的临床资料年龄、性别、血压、血浆Fg、血肌酐（Scr）、血尿素（Urea）、尿IgG、尿微量白蛋白（Alb）、24小时尿蛋白量]及与IgA肾病预后密切相关的病理资料（肾小球硬化、新月体形成、球囊粘连、肾小管萎缩、肾间质纤维化、肾小血管病变）进行分析。结果与无Fg沉积组比较，有如沉积组，血浆Fg水平增高（0．01〈P〈0，05），血Urea、尿IgG、尿微量Alb、24小时尿蛋白量显著增加（P〈0．01）；肾小球单纯IgA沉积的发生率下降（0．01〈P〈0．05），免疫球蛋白（Ig）单纯沉积于系膜区的发生率显著下降（P〈0．01），IgA＋IgG＋IgM共同沉积及Ig沉积于系膜区＋毛细血管襻的发生率显著升高（P〈0．01）；较为公认的IgA肾病预后不良因素中，大量蛋白尿（〉1．0g／24h）、肾间质纤维化的发生率增高（0．01〈P〈0．05），肾功能不全（Scr〉115μmol／L）、肾小球硬化、球囊粘连、肾小血管病变的发生率显著增高（P〈0．01）。结论肾小球内沉积的Fg参与了IgA肾病的临床病理过程，具有一定的致病作用。

Significance of intraglomerular deposition of Fibrinogen in IgA nephropathy.

Objective To study the significance of intraglomerular deposition of fibrinogen(Fg) in IgA nephropathy. Methods 103 patients were divided into two groups according to immunofluorescence results of renal biopsy: group A,without Fg deposition in the glomeruli;group B with Fg deposition in the gromeruli.Their clinical data(age,gender,blood pressure,plasma Fg,serum creatinine,serum urea,urine IgG,urine microalbumin,24 hour urine protein) and pathological data related to prognosis of IgA nephropathy were reviewed retrospectively. Results Between the two groups,higher levels of plasma Fg and significantly higher serum urea,urine IgG,urine microalbumin,24 hour urine protein were noted in group B(P<0.01),the incidence of Ig only depositing in the mesangial area was significantly lower(P<0.01),the incidence of IgA combined with IgG and IgM depositing in the glomeruli and Ig depositing in both mesangial area and capillary area were significantly higher(P<0.01);in the major risk factors on prognosis of IgA nephropathy,in group B there was a higher incidence of large proteinuria(>1.0g/24h) and renal interstitial fibrosis and significantly higher(P<0.01) incidence of renal insufficiency(>115umol/L),glomerulosclerosis,renal arteriolar lesion. Conclusion Fg depositing in the glomeruli played an important role in the clinical and pathological course of IgA nephropathy.