Wang H H, Fu L W, Yang L Y, Chen W P, Tsai S J, Lin C Y
Department of Pediatrics, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1997 Jan-Feb;38(1):21-7.
In an attempt to elucidate the relationship between serum IgG subclass/IgM ratio and prognosis in different types of idiopathic nephrotic syndrome (INS), 46 cases of treatment responders and 23 cases of either frequent relapse or non-responders were studied. All patients had received renal biopsy. Serum IgG subclass/IgM ratios were compared between the acute nephrotic phase and remission. The association between therapeutic effect and the parameters of INS were also investigated. There were 24 cases of minimal change nephrotic syndrome (MCNS), 32 cases of IgM nephropathy (IgMN) and 13 cases of focal segmental glomerular sclerosis (FSGS). All cases of MCNS were steroid-responders. Seventeen cases of IgMN experienced frequent relapses. The other 15 cases were responsive to the treatment. 6 cases of FSGS had poor response to any therapy; 7 cases were responsive to either triple therapy or cyclosporine A plus prednisolone. Both IgGI/IgM and IgG2/IgM were correlated with serum albumin and cholesterol levels at the acute nephrotic phase (p < 0.05). Longitudinal change of the immunologic parameters in patients with INS revealed significantly elevated serum IgM level decreased serum IgG level, IgG/IgM, IgG1/IgM, IgG2/IgM, IgG3/IgM, IgG4/IgM and IgG/IgE ratio during acute nephrotic phase. Correlation between therapy responses showed that, for serum IgG1/IgM ratio > 3.0, most of the cases were treatment-responders. For IgG1/IgM ratio > 1.0, all the cases were frequent relapsers or non-responders. These results suggest the immunologic changes in patients of INS may be caused by immune regulatory abnormality. Serum IgG1/IgM ratio may serve as one of the therapeutic and prognostic guides, especially if the patient refuses renal biopsy.
为阐明不同类型特发性肾病综合征（INS）患者血清IgG亚类/IgM比值与预后的关系，对46例治疗有反应者和23例频繁复发或无反应者进行了研究。所有患者均接受了肾活检。比较了急性肾病期和缓解期的血清IgG亚类/IgM比值。还研究了治疗效果与INS各项参数之间的关联。其中微小病变肾病（MCNS）24例，IgM肾病（IgMN）32例，局灶节段性肾小球硬化（FSGS）13例。所有MCNS病例对类固醇治疗均有反应。17例IgMN患者频繁复发，另外15例对治疗有反应。6例FSGS对任何治疗反应不佳；7例对三联疗法或环孢素A加泼尼松龙有反应。IgG1/IgM和IgG2/IgM在急性肾病期均与血清白蛋白和胆固醇水平相关（p<0.05）。INS患者免疫参数的纵向变化显示，急性肾病期血清IgM水平显著升高，血清IgG水平、IgG/IgM、IgG1/IgM、IgG2/IgM、IgG3/IgM、IgG4/IgM和IgG/IgE比值降低。治疗反应之间的相关性表明，血清IgG1/IgM比值>3.0时，大多数病例为治疗有反应者；IgG1/IgM比值>1.0时，所有病例均为频繁复发者或无反应者。这些结果提示，INS患者的免疫变化可能由免疫调节异常引起。血清IgG1/IgM比值可作为治疗和预后指导指标之一，尤其是在患者拒绝肾活检的情况下。
