Coppo R, Amore A, Cirina P, Messina M, Basolo B, Segoloni G, Berthoux F, Boulharouz R, Egido J, Alcazar R
Regina Margherita Children's Hospital, Torino, Italy.
Nephrol Dial Transplant. 1995 Dec;10(12):2310-5. doi: 10.1093/ndt/10.12.2310.
This study investigated whether abnormal circulation of macromolecular IgA and IgA with altered glycosylation or electrical charge plays a role in the recurrence of IgA nephropathy (IgAN) after transplantation.
A total of 92 renal transplant patients were enrolled; 52 IgAN patients and 40 with other non-IgAN. The IgAN group included 10 patients showing IgA mesangial deposits in the grafted kidneys (recurrent group) and 10 who did not (immunohistochemically proven non-recurrent group). In addition another 22 IgAN transplant patients were clinically free of recurrent disease.
The analyses included macromolecular IgA (IgAIC) detected by the conglutinin assay (K), heavy IgA precipitated in 2.5% polyethylene glycol (PEG), IgA-fibronectin aggregates (IgA/F Aggr), mixed IgA/IgGIC, IgA binding to mesangial matrix components (fibronectin, laminin, type IV collagen) or polycations (poly-L-lysine) and IgA with altered glycosylation (Jacalin-binding assay).
After transplantation, IgAN patients displayed significantly higher mean levels for each variable measured than non-IgAN (ANOVA, P < 0.05). By stepwise regression analysis, the binding of IgA to fibronectin had the highest coefficient. By comparing data in recurrent and clinically non-recurrent IgAN, we observed that two groups could be distinguished by the results of the two assays for macromolecular IgA (conglutinin IgAIC and IgA-fibronectin aggregates) and IgA with increased affinity for type IV collagen (P < 0.05). When the selected group of immunohistochemically proven non-recurrent IgAN was compared to the recurrent one, a statistically significant difference was found only for the binding of IgA to type IV collagen (P < 0.05). Data from this test were significantly related with proteinuria (P < 0.05) and microscopic haematuria (P < 0.04).
Even though the IgA serology of renal transplant IgAN patients shows peculiar features and recurrent and non-recurrent IgAN differ in many aspects, the prevalence of positive data in the two groups had no predictive value. This suggests that the recurrence of IgAN is modulated by factors affecting the interaction between circulating abnormal IgA and mesangial cells and/or matrix.
本研究调查了大分子IgA以及糖基化或电荷改变的IgA的异常循环是否在移植后IgA肾病（IgAN）的复发中起作用。
共纳入92例肾移植患者；52例IgAN患者和40例其他非IgAN患者。IgAN组包括10例移植肾中出现IgA系膜沉积的患者（复发组）和10例未出现的患者（免疫组化证实的非复发组）。此外，另有22例IgAN移植患者临床上无复发疾病。
分析包括通过凝集素测定（K）检测的大分子IgA（IgAIC）、在2.5%聚乙二醇（PEG）中沉淀的重链IgA、IgA - 纤连蛋白聚集体（IgA/F Aggr）、混合IgA/IgGIC、IgA与系膜基质成分（纤连蛋白、层粘连蛋白、IV型胶原）或聚阳离子（聚-L-赖氨酸）的结合以及糖基化改变的IgA（Jacalin结合测定）。
移植后，IgAN患者所测各变量的平均水平显著高于非IgAN患者（方差分析，P < 0.05）。通过逐步回归分析，IgA与纤连蛋白的结合系数最高。通过比较复发和临床未复发的IgAN患者的数据，我们观察到两组可通过大分子IgA的两种检测结果（凝集素IgAIC和IgA - 纤连蛋白聚集体）以及对IV型胶原亲和力增加的IgA来区分（P < 0.05）。当将免疫组化证实的非复发IgAN选定组与复发组进行比较时，仅发现IgA与IV型胶原的结合存在统计学显著差异（P < 0.05）。该检测数据与蛋白尿（P < 0.05）和镜下血尿（P < 0.04）显著相关。
尽管肾移植IgAN患者的IgA血清学表现出特殊特征，且复发和未复发的IgAN在许多方面存在差异，但两组中阳性数据的发生率无预测价值。这表明IgAN的复发受影响循环异常IgA与系膜细胞和/或基质之间相互作用的因素调节。
