中国全科医学 ›› 2023, Vol. 26 ›› Issue (21): 2632-2638.DOI: 10.12114/j.issn.1007-9572.2022.0847

• 论著 • 上一篇    下一篇

免疫球蛋白G4合并其他不同免疫球蛋白G亚型沉积的特发性膜性肾病患者的临床病理及短期预后分析

孙帅刚, 盛晓笑, 张文惠, 田慧娟, 翟亚玲*()   

  1. 450052 河南省郑州市,郑州大学第一附属医院肾脏内科
  • 收稿日期:2022-10-17 修回日期:2023-01-19 出版日期:2023-07-20 发布日期:2022-12-20
  • 通讯作者: 翟亚玲

  • 作者贡献:孙帅刚负责数据分析、文章的撰写;盛晓笑负责数据的收集、整理与核查;张文惠、田慧娟负责文献的收集与整理;翟亚玲负责文章的构思与设计、质量控制及审校,对文章整体负责。
  • 基金资助:
    国家自然科学基金青年科学基金项目(81600555); 中国博士后科学基金面上项目(2018M640684)

The Analysis of Clinicopathological Characters and Short-term Prognosis in Idiopathic Membranous Nephropathy Patients with Immunoglobulin G4 Combined with Other Different Immunoglobulin G Subtypes Deposition

SUN Shuaigang, SHENG Xiaoxiao, ZHANG Wenhui, TIAN Huijuan, ZHAI Yaling*()   

  1. Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
  • Received:2022-10-17 Revised:2023-01-19 Published:2023-07-20 Online:2022-12-20
  • Contact: ZHAI Yaling

摘要: 背景 特发性膜性肾病(IMN)患者病理上沉积的免疫球蛋白(Ig)G亚型以IgG4为主,亦可见IgG1、IgG2、IgG3的沉积,目前对于IMN中不同IgG亚型对肾脏病理损害作用的研究鲜见报道。 目的 本研究旨在探讨IgG4合并其他不同IgG亚型沉积的IMN患者的临床病理特征及短期预后。 方法 纳入2015年1月—2018年6月在郑州大学第一附属医院诊断为IMN的604例患者为研究对象,收集患者的基线资料,同时收集患者肾组织标本病理检查结果与治疗方案。根据患者肾脏病理IgG亚型的结果,将患者分为单纯IgG4沉积组(n=259)、IgG4合并IgG1沉积组(n=259)、IgG4合并IgG2沉积组(n=29)、IgG4合并IgG3沉积组(n=57)。以患者经皮肾脏穿刺活检术日期为起点,随访截至2018-11-06。绘制不同IgG亚型沉积患者预后的Kaplan-Meier生存曲线,生存曲线比较采用Log-rank检验。 结果 IgG4合并IgG1沉积组患者24 h尿蛋白高于单纯IgG4沉积组(P<0.05);IgG4合并IgG3沉积组患者白细胞计数、中性粒细胞计数、单核细胞计数、24 h尿蛋白高于单纯IgG4沉积组(P<0.05)。IgG4合并IgG1沉积组患者C3、C4、λ阳性沉积率高于单纯IgG4沉积组(P<0.05);IgG4合并IgG2沉积组患者C3阳性沉积率高于单纯IgG4沉积组(P<0.05);IgG4合并IgG3沉积组患者与单纯IgG4沉积组C3、C4、C1q阳性沉积率、肾小管萎缩半定量积分、肾间质纤维化半定量积分比较,差异有统计学意义(P<0.05)。Log-rank检验结果显示,四组患者累积缓解率比较,差异无统计学意义(χ2=0.684,P=0.408)。 结论 IgG4合并其他不同IgG亚型沉积患者较单纯IgG4沉积患者肾脏临床及病理改变更重,其中IgG4合并IgG3沉积患者具有更突出的临床病理表型。随访6个月缓解率无明显差异,可能与不同IgG亚型固定补体能力的不同,引起炎症反应强度不同有关。

关键词: 肾小球肾炎,膜性, 特发性膜性肾病, 免疫球蛋白G, 预后, 影响因素分析

Abstract:

Background

The immunoglobulin (Ig) G subtype deposited pathologically in patients with idiopathic membranous nephropathy (IMN) is mainly IgG4, and the deposition of IgG1, IgG2 and IgG3 can also be detected. At present, there has been no report on the damage effect of different IgG subtypes in IMN on the pathological of kidney.

Objective

The purpose of the study was to investigate the clinicopathological characters and short-term prognosis in IMN patients with IgG4 combined with other different IgG subtypes deposition.

Methods

604 patients diagnosed with IMN in the First Affiliated Hospital of Zhengzhou University from January 2015 to June 2018 were included in the study, the baseline information, pathological test results of renal tissue specimens and treatment protocols of the patients were collected. According to the test results of IgG subtypes in renal pathology, the patients were divided into the simple IgG4 deposition group (n=259) , IgG4 combined with IgG1 deposition group (n=259) , IgG4 combined with IgG2 deposition group (n=29) , and IgG4 combined with IgG3 deposition group (n=57) . Starting from the date of percutaneous renal biopsy, the follow-up was performed until 2018-11-06. Kaplan-Meier survival curves of patients with different IgG subtypes were plotted, Log-rank test was used for survival curve comparison.

Results

24-h urine protein in IgG4 combined with IgG1 deposition group was higher than that in the simple IgG4 deposition group (P<0.05) ; the white blood cell count, neutrophil count, monocyte count and 24-h urine protein in the IgG4 combined with IgG3 deposition group were higher than those in the simple IgG4 group (P<0.05) . The positive deposition rates of C3, C4 and λ in the IgG4 combined with IgG1 deposition group were higher than those in the simple IgG4 deposition group (P<0.05) ; the positive deposition rate of C3 in the IgG4 combined with IgG2 deposition group was higher than that in the simple IgG4 deposition group (P<0.05) ; the positive deposition rates of C3, C4 and C1q, semi-quantitative scores of renal tubular atrophy and renal interstitial fibrosis were significantly different between the IgG4 combined with IgG3 deposition group and the simple IgG4 deposition group (P<0.05) . Log-rank test results showed no significant difference in cumulative response rates among the four groups (χ2=0.684, P=0.408) .

Conclusion

The renal clinical and pathological changes were more serious in IgG4 combined with other different IgG subtypes patients than those with IgG4 alone, patients with IgG3 deposition had a more prominent clinicopathological phenotype. There was no significant difference in remission rate after 6 months of follow-up, which may be related to the different intensity of inflammatory response caused by different capacities to fix complement of different IgG subtypes.

Key words: Glomerulonephritis, membranous, Idiopathic membranous nephropathy, Immunoglobulin G, Prognosis, Root cause analysis