摘要
目的探讨有乙型肝炎病毒感染血清学证据的膜型狼疮肾炎（membranous lupusnephritis，MLN）和乙型肝炎病毒相关膜性肾病（hepatitis-B-virus associated membranous lupus nephritis，HBV-MN）中免疫荧光IgG亚型的不同表现，评价免疫荧光IgG亚型在鉴别两者中的诊断意义。方法总结了2012年1月至2013年10月在中日友好医院经肾穿刺活检术病理明确诊断的MLN和HBV-MN病例，从中选取有乙型肝炎病毒感染血清学证据（HBsAg和或HBeAg阳性）的患者。按最终诊断结果，将入选患者分为iMLN组和HBV-MN组，比较2组间在肾脏临床表现及肾小球免疫荧光IgG亚型的差异，并对其诊断价值进行评价。结果iMLN组35例，男8例，女27例，年龄19-58岁，平均年龄（31．43±10．2）岁；HBV-MN组21例，男11例，女10例，年龄21～69岁，平均年龄（44．9±14．5）岁。iMLN组C1q强度和阳性率均高于HBV-MN组（P=0．000，P=0．006）肾小球IgG亚型比较，IgGl沉积强度和阳性率方面在iMLN和HBV-MN两组比较无统计学差异，IgG2和IgG3沉积强度在iMLN组明显高于HBv-MN组（P=0．000，P=0．004），而IgG4沉积强度在HBV-MN要明显高于iMLN组（P=0．000）。IgG2、IgG3阳性率在iMLN组均高于HBV-MN组（均为P=0．002），而IgG4在HBV-MN组阳性率明显高于iMLN组（P=0．022）。根据IgG亚型荧光强度进行Logistic分析，显示IgG2和IgG4为主要影响因素。结论iMLN组以IgG1、IgG2和IgG3沉积为主，IgG4较弱或为阴性；HBV-MN组以IgG1、IgG4沉积为主，IgG2较弱，IgG3多为阴性。IgG2沉积强度在iMLN组中较HBV-MN组强。肾小球HBsAg和HBcAg免疫荧光结果不能作为鉴别两者的诊断依据，回归公式对于两组疾病的鉴别可能有一定意义。
Objective To investigate the difference between the membranous lupus nephritis infected with HBV（iMLN） and HBV associated membranous nephropathy （HBV-MN） in IgG subclass of renal irnmunofluorescence. Methods We analyzed the data of consecutive patients with iMLN and HBV-MN diagnosed by renal biopsy in China-Japan Friendship Hospital from January 2012 to October 2013. Clinical manifestations and characteristics of renal imrnunofluorescence staining for IgG subclass between iMLN and HBV-MN were analyzed. Results （1） The average age undergoing renal biopsy was 31.43 ± 10. 2 years in iMLN group （n = 35）, and 44. 9 ± 14. 5 years in HBV-MN group （n = 21） （2） The intensity and positive rate of C1q in iMLN were higher than those in HBV-MN （P = 0. 000, P = 0. 006）. （3） There was no significant difference in IgG1 between iMLN group and HBV-MN group. The intensity of IgG2 and IgG3 in iMLN was significantly higher than that in HBV-MN （P = 0. 000,P = 0. 004）, but the intensity of IgG4 in HBV-MN was significantly higher than that in iMLN （P = 0. 000）. The positive rate of IgG2 and IgG3 was significantly higher in iMLN than that in HBV- MN （P = 0. 002, P = 0. 002）. （4） Logistic regression analysis was performed. Explanatory variables entering Logistic regression equation were IgG2 and IgG4. Conclusions The deposits of IgG1, IgG2 and IgG3 were dominant and IgG4 was weak positive or negative in iMLN. In HBV-MN groups the deposits of IgG1 and IgG4 were dominant, and IgG3 was often negative or weak positive. The intensity of IgG2 in iMLN was higher than that in HBV-MN. The expression of HBsAg and HBcAg in renal immunofluorescenee was similar between two groups. Logistic equation could be helpful in differentiating from iMLN to HBV-MN.
出处
《临床肾脏病杂志》
2015年第8期465-468,共4页
Journal Of Clinical Nephrology
基金
慢性肾脏病诊治及管理关键技术推广(NO.Z131100002613004)
关键词
肾小球肾炎
膜性肾病
乙型肝炎病毒
IGG亚型
Glomerulonephritis
Membranous nephropathy
Hepatitis viruses
IgG subclasses
