Youssef D M, Salam S M Abdel, Karam R A
Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt.
Indian J Nephrol. 2011 Jul;21(3):186-90. doi: 10.4103/0971-4065.82638.
The purpose of this study was to estimate the serum levels of IgG, IgM, and IgA in nephrotic syndrome (NS) cases, in activity or in remission, and to detect their levels in relation to steroid response by evelautingthe relationship between IgG/IgM ratio and response to steroids. We investigated 27 cases with NS in activity and in remission and 20 healthy children as controls. Group A included 16 NS patients (12.3±1.4 years) who were steroid-resistant, frequent relapsers, or steroid dependent. Group B included 11 steroid-sensitive NS patients with a mean age of 11.6±2.1 years. Group C included 20 healthy children with a mean age of 12.1±2.3 years who were the control group. We found lower serum IgG level in NS cases compared with the control group; and it was lower in activity than in remission. The levels were lower in Group A compared with those of Group B. Serum IgG levels in Group A were as follows: in activity, 2.29±1.13 g/L and in remission, 4.3±2 g/L. In Group B, they were 6.2±1.2 g/L and 6.5±1.15 g/L in activity and in remission, respectively, and 11.8±2.5 g/L in the healthy control group (P<0.05). There was a direct correlation between serum albumin and serum IgG. We found no significant difference in serum IgM and IgA levels among studied groups whether in activity or in remission. Serum IgG/IgM ratio was lower in activity and in remission in the patient groups than in the control group as it was 9.3±4.7 in healthy subjects. It was 1.8±1.5 in Group A in activity and 3.2±2 in remission, and in Group B 4.8±2.39 in activity and 4.8±2.4 in remission. We conclude that IgM and IgA show no significant difference in NS patients. Serum IgG is lower in NS than in the control group and is much lower in activity than in remission. It is lower in patients with poor steroid response. We propose a predictive value of IgG/IgM ratio in activity, that is, the higher the IgG/IgM ratio in activity, the better the prognosis.
本研究的目的是评估肾病综合征（NS）活动期或缓解期患者血清中IgG、IgM和IgA的水平，并通过评估IgG/IgM比值与类固醇反应之间的关系来检测它们与类固醇反应相关的水平。我们调查了27例NS活动期和缓解期患者以及20名健康儿童作为对照。A组包括16例NS患者（12.3±1.4岁），他们对类固醇耐药、频繁复发或类固醇依赖。B组包括11例类固醇敏感的NS患者，平均年龄为11.6±2.1岁。C组包括20名健康儿童，平均年龄为12.1±2.3岁，作为对照组。我们发现NS患者的血清IgG水平低于对照组；活动期低于缓解期。A组的水平低于B组。A组血清IgG水平如下：活动期为2.29±1.13 g/L，缓解期为4.3±2 g/L。B组活动期和缓解期分别为6.2±1.2 g/L和6.5±1.15 g/L，健康对照组为11.8±2.5 g/L（P<0.05）。血清白蛋白与血清IgG之间存在直接相关性。我们发现研究组之间血清IgM和IgA水平在活动期或缓解期均无显著差异。患者组活动期和缓解期的血清IgG/IgM比值低于对照组，健康受试者为9.3±4.7。A组活动期为1.8±1.5，缓解期为3.2±2，B组活动期为4.8±2.39，缓解期为4.8±2.4。我们得出结论，NS患者的IgM和IgA无显著差异。NS患者的血清IgG低于对照组，活动期远低于缓解期。类固醇反应差的患者更低。我们提出活动期IgG/IgM比值具有预测价值，即活动期IgG/IgM比值越高，预后越好。
