發(fā)布時間：2018-04-14 10:04

  本文選題：原發(fā)性腎病綜合征 + 補體��； 參考：《延安大學》2014年碩士論文

【摘要】：目的探討原發(fā)性腎病綜合征免疫指標與臨床病理的相關性，為臨床病理診斷提供指導性意見。 方法回顧性分析延安大學附屬醫(yī)院腎內(nèi)科2011.12～2012.12經(jīng)腎活檢符合原發(fā)性腎病綜合征診斷標準，，且臨床資料齊全的患者，最終共91例納入分析。根據(jù)91例PNS患者臨床病理與補體C3、C4及免疫球蛋白IgG、IgA、IgM、IgE的關系，來進行性別、年齡、24h尿蛋白定量水平、血漿白蛋白水平、腎組織病理類型、腎組織免疫物質(zhì)沉積、腎小管間質(zhì)損傷程度等之間的分組，通過統(tǒng)計學處理來分析補體免疫球蛋白與臨床病理之間的關系。 結(jié)果 1.PNS患者的一般情況 91例患者的病理類型中，其中最多的是系膜增生性腎小球腎炎，36例，占39.6%，膜性腎病次之，28例，占30.8%，微小病變性腎病，12例，占13.2%，IgA腎病5例，占5.5%，局灶階段性腎小球硬化8例，占8.8%，和毛細血管內(nèi)增生性腎小球腎炎與系膜毛細血管性腎小球腎炎均各1例，各占1.1%。 2.補體、免疫球蛋白與一般資料的關系比較 原發(fā)性腎病綜合征患者女性的IgG、IgM水平明顯高于男性，男性的IgE水平明顯高于女性（P＜0.05），而IgA、C3、C4在性別間無差異（P＞0.05）；年齡組＞50歲組的血IgG水平明顯高于其它年齡組，20歲患者的血IgE水平顯著高于其它年齡組（P＜0.05）；IgA、IgM、C3、C4水平在各年齡組間無差異（P＞0.05）。 3.補體、免疫球蛋白與臨床資料的關系比較 尿蛋白定量高的組，IgA水平顯著高于較低水平組（P＜0.05）；血IgG、IgM、IgE、C3、C4在各尿蛋白定量組間無明顯差異（P＞0.05）；免疫球蛋白IgA與24h尿蛋白定量相關系數(shù)r=0.228，P=0.030，二者呈顯著正相關；回歸系數(shù)概率P=0.013，證明免疫球蛋白IgA與24h尿蛋白定量之間存在線性回歸關系；血漿白蛋白20g/L組的血IgG水平顯著低于其它組別（P＜0.05），IgA、IgM、IgE、C3、C4在各血漿白蛋白組間無差異（P＞0.05）。 4.補體、免疫球蛋白與腎臟病理類型的關系比較 91例患者腎臟組織中IgM陽性70例(76.92%)，IgG陽性67例(73.63%)，C3陽性42例(46.15%)，IgA陽性26例(28.57%)，腎臟免疫復合物中各免疫球蛋白及補體陽性率差異顯著(2=57.990，P＜0.001)，各腎臟病理類型免疫熒光比較差異顯著（P＜0.05），其中膜性腎病免疫熒光IgG、C3陽性者高于其他組，IgA腎病及局灶節(jié)段性腎小球硬化性腎小球腎炎免疫熒光IgA陽性者高于其他組，系膜增生性腎小球腎炎免疫熒光IgM陽性者高于其他組；腎組織免疫物質(zhì)沉積與血液中免疫球蛋白及補體濃度高低無直接相關（P＞0.05）；IgM、IgE、C3在各病理類型組間有明顯差異，F(xiàn)SGS的血IgE水平明顯低于其它組別（P＜0.05）；血IgG、IgA、C4在各病理類型組間無差異，IgA腎病患者血IgA水平與其它各組無差異（P＞0.05）；腎小管間質(zhì)損傷程度TID=0分者血IgE水平明顯高于1～4分者（P＜0.05）。 結(jié)論 1.IgE水平高的年輕男性患者，病理損害可能較輕，對治療反應較好，預后較好。年齡大于50歲的女性患者血IgG水平明顯高于其它組。 2.本研究提示血IgA水平越高，可能24h尿蛋白定量越高；血IgG水平顯著降低的患者血漿白蛋白較低，可能體內(nèi)存在高凝狀態(tài)，應盡早給予預防性抗凝治療。 3.腎臟免疫復合物中各免疫球蛋白及補體陽性率有差異，各腎臟病理類型免疫熒光比較有差異。血IgE和C3水平低的患者可能的病理損害為FSGS。
[Abstract]:Objective to investigate the correlation between the immunological indices of primary nephrotic syndrome and the clinicopathology, and to provide guidance for clinicopathological diagnosis.
Methods a retrospective analysis of Nephrology Affiliated Hospital of Yan'an University from 2011.12 to 2012.12 by renal biopsy with primary nephrotic syndrome diagnostic criteria, and the complete clinical data of patients, the final total of 91 were included in the analysis. According to the 91 cases of PNS patients with clinical pathology and complement C3, C4 and immunoglobulin IgG, IgA, IgM, IgE, to gender, age, 24h urine protein, plasma albumin, renal pathologic, deposition of immune substances of kidney, renal tubule interstitial injury degree of the group, to analyze the relationship between complement immune globulin and clinical pathology through statistical analysis.
Result
General situation of 1.PNS patients
The pathological type of 91 patients, most of them are mesangial proliferative glomerulonephritis, 36 cases, accounting for 39.6%, membranous nephropathy of 28 cases, accounting for 30.8%, minimal change disease, 12 cases, accounting for 13.2%, 5 cases of IgA nephropathy, accounted for 5.5%, focal segmental sclerosis in 8 cases, accounting for 8.8%, and endocapillary proliferative glomerulonephritis and mesangiocapillary glomerulonephritis were 1 cases, accounted for 1.1%.
The relationship between 2. complement, immunoglobulin and general data
Primary nephrotic syndrome in women with IgG, the level of IgM was significantly higher than that of male, male IgE level was significantly higher than that in female (P < 0.05), while IgA, C3, C4 no difference in gender (P > 0.05); the blood level of IgG age group more than 50 year old group was significantly higher than that in other age groups, the blood the level of IgE at the age of 20 patients was significantly higher than that of other age groups (P < 0.05); IgA, IgM, C3, C4 level had no difference in the age groups (P > 0.05).
Comparison of the relationship between 3. complement, immunoglobulin and clinical data
Urinary protein quantitative high group, IgA level was significantly higher than that of the lower level group (P < 0.05); blood IgG, IgM, IgE, C3, C4 showed no significant difference in the quantity of urinary protein between the groups (P > 0.05); immunoglobulin IgA and 24h urinary protein excretion coefficient r=0.228, P=0.030 was significant two positive correlation; regression coefficient probability P=0.013, prove the existence of linear regression relationship between immunoglobulin IgA and 24h urinary protein; blood IgG levels of plasma 20g/L were significantly lower than those of other groups (P < 0.05), IgA, IgM, IgE, C3, C4 in the plasma albumin groups had no difference (P > 0.05).
The relationship between 4. complement, immunoglobulin and renal pathological type
91 cases of kidney tissues of patients with IgM positive in 70 cases (76.92%), 67 cases were IgG positive (73.63%), 42 cases were C3 positive (46.15%), 26 cases were IgA positive (28.57%), the difference in the renal immune complexes of immunoglobulin and complement the positive rate significantly (2=57.990, P < 0.001), the kidney disease type immunofluorescence was significantly different (P < 0.05), the membranous nephropathy immunofluorescence IgG, C3 were higher than other groups, IgA nephropathy and focal segmental glomerular sclerosing glomerulonephritis immunofluorescence IgA positive is higher than the other group, mesangial proliferative glomerulonephritis immunofluorescence IgM positive was higher than other groups no; directly related to renal tissue deposition of immune substance and blood immunoglobulin and complement levels (P > 0.05); IgM, IgE, there are significant differences in different pathological types between group C3, serum IgE levels of FSGS were significantly lower than that of other groups (P < 0.05); blood IgG, IgA, C4 in the pathology type group There was no difference in blood IgA level between IgA nephropathy patients and other groups (P > 0.05). The level of renal tubule interstitial injury was significantly higher than that of 1~4 points in TID=0 patients (P < 0.05).
conclusion
Young male patients with a high level of 1.IgE may have mild pathological damage, better response to treatment and better prognosis. The serum IgG level of women over 50 years old is significantly higher than that of other groups.
2., this study indicates that the higher the serum IgA level is, the higher the 24h urinary protein will be. The plasma albumin of patients with significantly decreased serum IgG level may be hypercoagulable. Therefore, anticoagulant therapy should be given as early as possible.
3., the immunoglobulin and complement positive rates in renal immune complexes were different. There was a difference in immunofluorescence between each renal pathological type. The possible pathological damage in patients with low serum IgE and C3 level was FSGS..

【學位授予單位】：延安大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692

【參考文獻】

相關期刊論文 前10條

1 曾智鳳;易著文;吳小川;何小解;黨西強;莫雙紅;;61例難治性腎病兒童IgM沉積與腎臟病理關系分析[J];醫(yī)學臨床研究;2008年04期

2 唐政,黎磊石,俞雨生,王慶文,張景紅,季大璽,張苗,蔣煒;1秒鐘快速經(jīng)皮腎活檢術(附1507例術后并發(fā)癥分析)[J];解放軍醫(yī)學雜志;1989年06期

3 王慶文;黎磊石;季大璽;周惠忠;唐政;;經(jīng)皮腎穿刺活檢:1秒鐘快速穿刺法(附1400例術后的并發(fā)癥分析)[J];金陵醫(yī)院院刊;1988年01期

4 杜開先;羅予;張艷;;兒童單純性腎病綜合征血清IgG、IgA、IgM、補體C3測定及與血漿清蛋白和尿蛋白關系[J];臨床檢驗雜志;2008年04期

5 劉剛,馬序竹,鄒萬忠,王梅,王海燕;腎活檢患者腎臟病構(gòu)成十年對比分析[J];臨床內(nèi)科雜志;2004年12期

6 羅曉菊,李秋;腎病綜合征患兒免疫球蛋白檢測與應用激素的探討[J];實用兒科臨床雜志;2005年05期

7 何金華;李志輝;段翠蓉;吳天慧;銀燕;羅春華;;紫癜性腎炎患兒蛋白尿、免疫病理和體液免疫的關系[J];實用兒科臨床雜志;2008年05期

8 姚小丹;王慶文;俞雨生;黎磊石;;一種更實用更安全的腎活檢技術——斜角進針負壓吸引法[J];腎臟病與透析腎移植雜志;1993年05期

9 陳惠萍,曾彩虹,胡偉新,王慶文,俞雨生,姚小丹,唐政,王建平,朱茂艷,周虹,劉紅,劉志紅,黎磊石;10594例腎活檢病理資料分析[J];腎臟病與透析腎移植雜志;2000年06期

10 曾彩虹,陳惠萍,俞雨生,胡偉新,王慶文,姚小丹,唐政,王建平,朱茂艷,周虹,劉志紅,黎磊石;22年腎活檢資料的流行病學分析[J];腎臟病與透析腎移植雜志;2001年01期

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