膜性肾病患者肾小球 IgG4 沉积缺失可能提示恶性肿瘤。

Absence of glomerular IgG4 deposition in patients with membranous nephropathy may indicate malignancy.

机构信息

Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.

出版信息

Nephrol Dial Transplant. 2012 May;27(5):1931-7. doi: 10.1093/ndt/gfr534. Epub 2011 Oct 5.

DOI:10.1093/ndt/gfr534

PMID:21976738

Abstract

BACKGROUND

The renal pathological manifestations of malignancy-associated membranous nephropathy (M-MN) and idiopathic membranous nephropathy (I-MN) are similar. It has been suggested that glomerular IgG4 deposition may play an important role in the pathogenesis of I-MN. In the present study, we compared the IgG subclass of immune complex deposition, clinical data and pathological data of patients with M-MN and I-MN.

METHODS

Eight patients with M-MN and 42 patients with I-MN diagnosed between 1997 and 2009 in our hospital were enrolled. The clinical and pathological data were retrospectively collected, and glomerular IgG subclass deposition was detected by immunohistochemistry.

RESULTS

Patients with M-MN were older (P = 0.003), with lower serum albumin (P = 0.034) and higher serum C-reactive protein (CRP) level (P = 0.003) than patients with I-MN. The majority of patients with M-MN had earlier pathological stages (P = 0.003) and less IgG deposition in glomeruli (P = 0.029). Absence of IgG4 deposition in glomeruli was notably observed in patients with M-MN (7/8 in M-MN versus 6/42 in I-MN, P < 0.001) and it was an independent predictor for occurrence of malignancy (hazard ratio 0.065, 95% confidence intervals 0.007-0.571, P = 0.014).

CONCLUSION

Absence of glomerular IgG4 deposition, together with older age, severe hypoalbuminemia and high serum CRP level could be useful clues to differentiate M-MN from I-MN.

摘要

背景

恶性肿瘤相关膜性肾病（M-MN）和特发性膜性肾病（I-MN）的肾脏病理表现相似。有研究提示，肾小球 IgG4 沉积可能在 I-MN 的发病机制中发挥重要作用。本研究比较了 M-MN 和 I-MN 患者免疫复合物沉积的 IgG 亚类、临床和病理资料。

方法

收集我院 1997 年至 2009 年间诊断的 8 例 M-MN 患者和 42 例 I-MN 患者的临床和病理资料，采用免疫组化方法检测肾小球 IgG 亚类沉积。

结果

M-MN 患者年龄较大（P = 0.003），血清白蛋白水平较低（P = 0.034），C 反应蛋白（CRP）水平较高（P = 0.003）。与 I-MN 患者相比，M-MN 患者的病理分期更早（P = 0.003），肾小球 IgG 沉积更少（P = 0.029）。M-MN 患者的肾小球中明显未见 IgG4 沉积（M-MN 中 7/8 例，I-MN 中 6/42 例，P < 0.001），且这是恶性肿瘤发生的独立预测因素（风险比 0.065，95%置信区间 0.007-0.571，P = 0.014）。