用PCR-SSO检测IgA肾炎HLA-DRB1、DQA1、DQB1等位基因及其临床意义

利用聚合酶链区应（PCR）和序列特异性寡核苷酸（SSO）探针技术对47例经临床及免疫荧光证实的IgA肾病（IgAN）患者HLA-DRB1、DQA1、DQB1等位基因频率进行了检测。结果显示IgAN患者组DR4基因频率明显高于正常人组,相反DQB1*0602基因频率与对照组相比呈显著下降。IgAN患者中蛋白尿组DR4基因频率显著高于对照组,而肉眼血尿组与对照组无显著差异。约 1/4 DR4基因阳性的IgAN病理表现为局灶节段硬化性肾小球肾炎。 IgAN肾衰组DR4阳性的发生率显著高于非肾衰组。由此可见,IgAN中HLA-DR4基因频率而著增高, DR4阳性IgAN临床多表现蛋白尿,易发生肾衰,病理多呈局灶节段硬化型;DQB1*0602等位基因对IgAN可能有一定抵抗性。这些研究结果提示IgAN有免疫遗传的背景。

Investigation of the Allele HLA-DRB1, DQA1, DQB1 in IgA Nephropathy Using PCR-SSO and its Clinical Implication

HLA-DRB1, DQAl, DQB1 allele were detected in 47 patients clinical and biopsy proven primary IgA nephropathy (IgAN) using polymerase chain reaction (PCR) and sequence specific oligonucleoside (SSO) technique. The results showed that the gene frequency (GF) of DR4 was significantly higher in patients with IgAN than that in normal controls. In contrary, the GF of DRB1*0602 was significantly lower in IgAN than that in controls. A significantly higher GF of DR4 was observed in patients with proteinuria, while the GF of DR4 was similarly high in the gross hematuria group and control group. About 1/4 DR4 positive patients were observed focal segmental glomerular sclerosis by light microscope. There was a significant increase in the rate of DR4 positive in patients with renal failure compared with the patients with normal renal function. These findings suggest the GF of FILA-DR4 increases significantly in IgAN. IgAN with DR4 positive usually present proteinuria. Majority of them have renal failure and show the focal segmental sclerosis under light microscopy. DRB1 *0602 allele may have the resistance to IgAN. It is thus concluded that IgAN have the FILA immunogenetic background.