Fu L W, Yang L Y, Chen W P, Tsai S J, Lin C Y
Department of Pediatrics, Veterans General Hospital-Taipei, Institute of Clinical Medicine, National Yang-Ming University, Taiwan, Republic of China.
Pediatr Nephrol. 1998 Nov;12(9):761-3. doi: 10.1007/s004670050541.
Focal segmental glomerulosclerosis (FSGS) is relatively steroid resistant and no clinical or histological marker can predict the response to therapy. To investigate the role of serum immunoglobulin subclass/IgM in predicting the response to therapy in FSGS, serum concentrations of total IgG, IgG subclasses, and the ratio of serum IgG subclasses to total IgG (% IgG subclass) were measured in 27 children during the acute nephrotic state. Prednisolone, cyclophosphamide, and Persantine (dipyridamole) were given for 12 weeks. We divided the patients into good responders or poor responders according to clinical response. The clinical and nephrotic status were similar in both groups. Fourteen patients were good responders with higher serum IgGI/IgM than that of non-responders (4.00+/-0.67 vs. 1.61+/-0.20, P<0.05). There was no significant difference in IgG2/IgM between these two groups. These results suggest that higher serum IgGI/IgM ratios may be associated with a better clinical response. These changes may reflect dysregulation of immunoglobulin class switching in patients with FSGS.
局灶节段性肾小球硬化（FSGS）相对激素抵抗，尚无临床或组织学标志物能够预测治疗反应。为研究血清免疫球蛋白亚类/IgM在预测FSGS治疗反应中的作用，在27例处于急性肾病状态的儿童中检测了总IgG、IgG亚类的血清浓度以及血清IgG亚类与总IgG的比值（%IgG亚类）。给予泼尼松龙、环磷酰胺和潘生丁（双嘧达莫）治疗12周。根据临床反应将患者分为反应良好者或反应不佳者。两组患者的临床和肾病状态相似。14例反应良好者的血清IgG1/IgM高于无反应者（4.00±0.67对1.61±0.20，P<0.05）。两组之间的IgG2/IgM无显著差异。这些结果表明，较高的血清IgG1/IgM比值可能与更好的临床反应相关。这些变化可能反映了FSGS患者免疫球蛋白类别转换的失调。
