Xu Xiao-Meng, Zhu Shuang-Shuang, Wang Xiao-Hong, Shao Xiao-Fei, Li Bin, Zhang Ying, Liu Qin, Li Jia-Min, Wang Hong-Lei, Li Yong-Qiang, Zou He-Qun
Institute of Nephrology and Urology, Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China.E-mail:
Nan Fang Yi Ke Da Xue Xue Bao. 2017 Mar 20;37(3):308-311. doi: 10.3969/j.issn.1673-4254.2017.03.05.
To investigate the relationship between the clinical and pathological findings in IgA nephropathy with or without IgG deposition in the glomerular mesangial area.
The data were collected from 122 patients with a diagnosis of IgA nephropathy by renal biopsy in the Third Affiliated Hospital of Southern Medical University between November, 2009 and February, 2016. All the samples were examined by light microscopy, immunofluorescence and electron microscopy. According to the results of immunofluorescence assay, the patients were divided into IgA group (n=63) and IgA-IgG group (n=59). The pathological classification of IgA nephropathy was analyzed according to Oxford classification and Lee's classification. The clinical and pathological findings were compared between the two groups.
Compared with the patients with IgA nephropathy but without IgG deposition, patients with IgA nephropathy with IgG deposition had higher serum creatinine, higher 24-h urine protein, higher blood uric acid, higher triglyceride levels (P<0.05) and lower eGFR (P<0.05); more of these patients were in Lee's grade IV-V, had renal tubular atrophy and/or interstitial fibrosis, and had MEST scores more than 3 (P<0.05).
Patients with IgA nephropathy with IgG deposition in the glomerular mesangial have severer clinical symptoms and more serious pathological changes. Measures should be taken to control IgG deposition in patients with IgA nephropathy to delay the progress of the disease.
探讨肾小球系膜区有或无IgG沉积的IgA肾病临床与病理表现之间的关系。
收集2009年11月至2016年2月在南方医科大学第三附属医院经肾活检确诊为IgA肾病的122例患者的数据。所有样本均行光镜、免疫荧光及电镜检查。根据免疫荧光检测结果,将患者分为IgA组(n = 63)和IgA-IgG组(n = 59)。依据牛津分类法和李氏分类法对IgA肾病进行病理分类。比较两组的临床及病理表现。
与无IgG沉积的IgA肾病患者相比,有IgG沉积的IgA肾病患者血清肌酐、24小时尿蛋白、血尿酸、甘油三酯水平更高(P < 0.05),估算肾小球滤过率更低(P < 0.05);这些患者中更多处于李氏分级IV - V级,存在肾小管萎缩和/或间质纤维化,且系膜增殖、内皮细胞增生、节段性硬化及肾小管间质病变评分大于3分(P < 0.05)。
肾小球系膜区有IgG沉积的IgA肾病患者临床症状更严重,病理改变更明显。应采取措施控制IgA肾病患者的IgG沉积,以延缓疾病进展。