原发性肾病综合征补体、免疫球蛋白与临床病理分析

发布时间：2018-04-14 10:04

本文选题：原发性肾病综合征 + 补体　；参考：《延安大学》2014年硕士论文

【摘要】：目的探讨原发性肾病综合征免疫指标与临床病理的相关性，为临床病理诊断提供指导性意见。方法回顾性分析延安大学附属医院肾内科2011.12～2012.12经肾活检符合原发性肾病综合征诊断标准，，且临床资料齐全的患者，最终共91例纳入分析。根据91例PNS患者临床病理与补体C3、C4及免疫球蛋白IgG、IgA、IgM、IgE的关系，来进行性别、年龄、24h尿蛋白定量水平、血浆白蛋白水平、肾组织病理类型、肾组织免疫物质沉积、肾小管间质损伤程度等之间的分组，通过统计学处理来分析补体免疫球蛋白与临床病理之间的关系。结果 1.PNS患者的一般情况 91例患者的病理类型中，其中最多的是系膜增生性肾小球肾炎，36例，占39.6%，膜性肾病次之，28例，占30.8%，微小病变性肾病，12例，占13.2%，IgA肾病5例，占5.5%，局灶阶段性肾小球硬化8例，占8.8%，和毛细血管内增生性肾小球肾炎与系膜毛细血管性肾小球肾炎均各1例，各占1.1%。 2.补体、免疫球蛋白与一般资料的关系比较原发性肾病综合征患者女性的IgG、IgM水平明显高于男性，男性的IgE水平明显高于女性（P＜0.05），而IgA、C3、C4在性别间无差异（P＞0.05）；年龄组＞50岁组的血IgG水平明显高于其它年龄组，20岁患者的血IgE水平显著高于其它年龄组（P＜0.05）；IgA、IgM、C3、C4水平在各年龄组间无差异（P＞0.05）。 3.补体、免疫球蛋白与临床资料的关系比较尿蛋白定量高的组，IgA水平显著高于较低水平组（P＜0.05）；血IgG、IgM、IgE、C3、C4在各尿蛋白定量组间无明显差异（P＞0.05）；免疫球蛋白IgA与24h尿蛋白定量相关系数r=0.228，P=0.030，二者呈显著正相关；回归系数概率P=0.013，证明免疫球蛋白IgA与24h尿蛋白定量之间存在线性回归关系；血浆白蛋白20g/L组的血IgG水平显著低于其它组别（P＜0.05），IgA、IgM、IgE、C3、C4在各血浆白蛋白组间无差异（P＞0.05）。 4.补体、免疫球蛋白与肾脏病理类型的关系比较 91例患者肾脏组织中IgM阳性70例(76.92%)，IgG阳性67例(73.63%)，C3阳性42例(46.15%)，IgA阳性26例(28.57%)，肾脏免疫复合物中各免疫球蛋白及补体阳性率差异显著(2=57.990，P＜0.001)，各肾脏病理类型免疫荧光比较差异显著（P＜0.05），其中膜性肾病免疫荧光IgG、C3阳性者高于其他组，IgA肾病及局灶节段性肾小球硬化性肾小球肾炎免疫荧光IgA阳性者高于其他组，系膜增生性肾小球肾炎免疫荧光IgM阳性者高于其他组；肾组织免疫物质沉积与血液中免疫球蛋白及补体浓度高低无直接相关（P＞0.05）；IgM、IgE、C3在各病理类型组间有明显差异，FSGS的血IgE水平明显低于其它组别（P＜0.05）；血IgG、IgA、C4在各病理类型组间无差异，IgA肾病患者血IgA水平与其它各组无差异（P＞0.05）；肾小管间质损伤程度TID=0分者血IgE水平明显高于1～4分者（P＜0.05）。结论 1.IgE水平高的年轻男性患者，病理损害可能较轻，对治疗反应较好，预后较好。年龄大于50岁的女性患者血IgG水平明显高于其它组。 2.本研究提示血IgA水平越高，可能24h尿蛋白定量越高；血IgG水平显著降低的患者血浆白蛋白较低，可能体内存在高凝状态，应尽早给予预防性抗凝治疗。 3.肾脏免疫复合物中各免疫球蛋白及补体阳性率有差异，各肾脏病理类型免疫荧光比较有差异。血IgE和C3水平低的患者可能的病理损害为FSGS。
[Abstract]:Objective to investigate the correlation between the immunological indices of primary nephrotic syndrome and the clinicopathology, and to provide guidance for clinicopathological diagnosis.
Methods a retrospective analysis of Nephrology Affiliated Hospital of Yan'an University from 2011.12 to 2012.12 by renal biopsy with primary nephrotic syndrome diagnostic criteria, and the complete clinical data of patients, the final total of 91 were included in the analysis. According to the 91 cases of PNS patients with clinical pathology and complement C3, C4 and immunoglobulin IgG, IgA, IgM, IgE, to gender, age, 24h urine protein, plasma albumin, renal pathologic, deposition of immune substances of kidney, renal tubule interstitial injury degree of the group, to analyze the relationship between complement immune globulin and clinical pathology through statistical analysis.
Result
General situation of 1.PNS patients
The pathological type of 91 patients, most of them are mesangial proliferative glomerulonephritis, 36 cases, accounting for 39.6%, membranous nephropathy of 28 cases, accounting for 30.8%, minimal change disease, 12 cases, accounting for 13.2%, 5 cases of IgA nephropathy, accounted for 5.5%, focal segmental sclerosis in 8 cases, accounting for 8.8%, and endocapillary proliferative glomerulonephritis and mesangiocapillary glomerulonephritis were 1 cases, accounted for 1.1%.
The relationship between 2. complement, immunoglobulin and general data
Primary nephrotic syndrome in women with IgG, the level of IgM was significantly higher than that of male, male IgE level was significantly higher than that in female (P < 0.05), while IgA, C3, C4 no difference in gender (P > 0.05); the blood level of IgG age group more than 50 year old group was significantly higher than that in other age groups, the blood the level of IgE at the age of 20 patients was significantly higher than that of other age groups (P < 0.05); IgA, IgM, C3, C4 level had no difference in the age groups (P > 0.05).
Comparison of the relationship between 3. complement, immunoglobulin and clinical data
Urinary protein quantitative high group, IgA level was significantly higher than that of the lower level group (P < 0.05); blood IgG, IgM, IgE, C3, C4 showed no significant difference in the quantity of urinary protein between the groups (P > 0.05); immunoglobulin IgA and 24h urinary protein excretion coefficient r=0.228, P=0.030 was significant two positive correlation; regression coefficient probability P=0.013, prove the existence of linear regression relationship between immunoglobulin IgA and 24h urinary protein; blood IgG levels of plasma 20g/L were significantly lower than those of other groups (P < 0.05), IgA, IgM, IgE, C3, C4 in the plasma albumin groups had no difference (P > 0.05).
The relationship between 4. complement, immunoglobulin and renal pathological type
91 cases of kidney tissues of patients with IgM positive in 70 cases (76.92%), 67 cases were IgG positive (73.63%), 42 cases were C3 positive (46.15%), 26 cases were IgA positive (28.57%), the difference in the renal immune complexes of immunoglobulin and complement the positive rate significantly (2=57.990, P < 0.001), the kidney disease type immunofluorescence was significantly different (P < 0.05), the membranous nephropathy immunofluorescence IgG, C3 were higher than other groups, IgA nephropathy and focal segmental glomerular sclerosing glomerulonephritis immunofluorescence IgA positive is higher than the other group, mesangial proliferative glomerulonephritis immunofluorescence IgM positive was higher than other groups no; directly related to renal tissue deposition of immune substance and blood immunoglobulin and complement levels (P > 0.05); IgM, IgE, there are significant differences in different pathological types between group C3, serum IgE levels of FSGS were significantly lower than that of other groups (P < 0.05); blood IgG, IgA, C4 in the pathology type group There was no difference in blood IgA level between IgA nephropathy patients and other groups (P > 0.05). The level of renal tubule interstitial injury was significantly higher than that of 1~4 points in TID=0 patients (P < 0.05).
conclusion
Young male patients with a high level of 1.IgE may have mild pathological damage, better response to treatment and better prognosis. The serum IgG level of women over 50 years old is significantly higher than that of other groups.
2., this study indicates that the higher the serum IgA level is, the higher the 24h urinary protein will be. The plasma albumin of patients with significantly decreased serum IgG level may be hypercoagulable. Therefore, anticoagulant therapy should be given as early as possible.
3., the immunoglobulin and complement positive rates in renal immune complexes were different. There was a difference in immunofluorescence between each renal pathological type. The possible pathological damage in patients with low serum IgE and C3 level was FSGS..

【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692

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