表现为肾病综合征的局灶节段性肾小球硬化患儿肾组织免疫荧光沉积情况和糖皮质激素疗效的关系

发布时间：2018-05-24 11:19

本文选题：肾病综合征 + 局灶节段性肾小球硬化　；参考：《上海交通大学学报(医学版)》2017年10期

【摘要】：目的·分析表现为肾病综合征的局灶节段性肾小球硬化(FSGS)患儿肾组织免疫荧光沉积情况和糖皮质激素疗效的关系。方法·回顾性分析1990年1月至2015年12月在上海交通大学医学院附属新华医院小儿肾脏内科临床诊断为肾病综合征并行肾穿刺活检明确病理类型为FSGS患儿的肾组织免疫荧光沉积情况及临床随访资料。结果·47例表现为肾病综合征的FSGS患儿,免疫荧光类型分布:IgA为主型2例(占4.26%)、IgM为主型7例(占14.89%)、补体为主型4例(占8.51%)、IgG+A+M型1例(占2.13%)、IgG+A+M补体型5例(占10.64%)、IgA+补体型1例(占2.13%)、IgM+补体型12例(占25.53%)、无免疫复合物型15例(占31.91%)。免疫荧光沉积情况:IgA~+有9例,IgM~+有25例,IgG~+有8例,C3~+有23例,C4~+有3例,C1q~+有6例,FN~+有5例,免疫荧光沉积全阴性的有12例。口服泼尼松足量治疗4周后完全缓解34例(占72.34%),部分缓解7例(占14.89%),无缓解6例(占12.77%)。不同免疫荧光类型患者间的激素疗效差异无统计学意义(H=1.792,P=0.408);不同免疫荧光沉积情况中C1q~+与C1q-患者的激素疗效差异有统计学意义(χ~2=7.22,P=0.027),余组间差异均无统计学意义。结论·对于表现为肾病综合征的FSGS患儿,若肾组织有C1q沉积,则糖皮质激素对其的疗效相对较差。
[Abstract]:Objective to analyze the relationship between renal tissue immunofluorescence deposition and glucocorticoid effect in children with focal segmental glomerulosclerosis (FSGS) with nephrotic syndrome. Methods from January 1990 to December 2015, the renal tissues of children with nephrotic syndrome diagnosed as nephrotic syndrome by renal puncture biopsy in the Department of Pediatric Nephrology, affiliated Xinhua Hospital of Shanghai Jiaotong University Medical College, Shanghai Jiaotong University, were analyzed retrospectively. Immunofluorescence deposition and clinical follow-up data. Results there were 47 cases of FSGS with nephrotic syndrome. Immunofluorescence distribution of IgA in 2 cases (4.26%) and IgM in 7 cases (14.89%), complement predominant type in 4 cases (8.51%) and IgG-A M type in 1 case (2.13%) in 5 cases (10.64%) in 1 case (2.13%) in 12 cases (25.53%), in which there were 12 cases (25.53%). 15 cases of immune complex type (31.91%). Immunofluorescence deposition in 9 cases IgM25 cases of IgG ~ 8 cases of C _ 3 ~ 23 cases of C _ 4 ~ 3 cases of C _ 1Q ~ 6 cases of FNs, 12 cases of negative immunofluorescence deposition. After 4 weeks of oral prednisone, 34 cases (72.34%) had complete remission, 7 cases (14.89%) had partial remission, and 6 cases (12.77%) had no remission. There was no significant difference in hormone efficacy between different immunofluorescence types (P < 0.05), but there was no significant difference in hormone efficacy between C1q- and C1q- patients in different immunofluorescence deposition (蠂 ~ 2, 7.22, P ~ (0.027), but there was no significant difference between the other groups. Conclusion the effect of glucocorticoid on FSGS children with nephrotic syndrome is relatively poor if there is C1q deposition in renal tissue.
【作者单位】：上海交通大学医学院附属新华医院小儿肾脏内科;
【分类号】：R726.9

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