目的探讨肾活检免疫病理“满堂亮”（指肾组织免疫荧光染色IgG、IgA、IgM、C3、C1q同时阳性）的现象与临床肾脏疾病关系。方法对1984～1999年有完整临床资料及肾活检免疫荧光呈“满堂亮”的50例病例进行分析。结果50例“满堂亮”的诊断为：(1)狼疮性肾炎21例，其病理改变Ⅱ型（系膜增生型）4例,Ⅲ型（局灶节段型）5例,Ⅳ型（弥漫增殖型）9例，V型（膜型）3例。(2)乙型肝炎病毒相关肾炎13例，其病理为轻系膜增生型4例；膜性肾病7例；膜增生型肾小球肾炎2例。(3)过敏性紫瘢性肾炎（均为肾病型）9例。(4)IgA肾病6例。(5)抗中性粒细胞胞浆抗体阳性的急进性肾小球肾炎1例。结论(1)“满堂亮”现象可见于多种肾小球疾病，最多见于狼疮性肾炎，是狼疮性肾炎最有特征性的免疫病理改变。(2)“满堂亮”现象也可出现于乙型肝炎病毒相关肾炎。(3)对呈‘满堂亮’而临床诊断为非狼疮性肾炎的病例应追踪观察，尤应注意其与狼疮性肾炎的密切关系。以便发现某些延迟出现狼疮血清学阳性反应的和(或)狼疮临床表现的狼疮患者。%Objective The “full-house” immunofluorescent staining ischaracterized by positive staining of IgG, IgA, IgM, C3 as well as C1q in the glomerualr mesangium and along the glomerular basement membrane, which is one of the features of lupus nephritis (LN). There are few reports discussing the significance of the “full-house” immunofluorescent staining in various glomerular diseases. The authors aimed to analyze case-by-case the clinical manifestations and renal biopsy specimens and interpret the clinicopathologic correlations of the “full-house” immunofluorescent staining in glomerular diseases. Methods There were 50 out of 450 renal biopsies described as having “full-house” immunofluorescent staining in renal specimens from 1984 to 1999. The clinical data of the 50 cases with “full-house” immunofluorescent staining were retrospectively analyzed and investigated. Results Totally 10.1% （50/450）renal specimens presented “full-house” immunofluorescent staining. Among the 50 cases as “full-house” immunofluorescent staining, the renal pathology showed various lesions. (1)Twenty-one of 50 cases with “full-house” immunofluorescent staining were LN including 4 cases with Class II LN, 5 cases with Class III, 9 cases with Class IV and 3 cases with Class V. (2)Thirteen of 50 cases were hepatitis B virus related glomerulonephritis (HBV-GN) including 4 cases with mild mesangioproliferative glomerulonephritis, 7 with membranous nephropathy and 2 with membranoproliferative glomerulonephritis. (3) Nine of 50 cases were purpura nephritis and presented clinically with nephrotic syndrome. (4) Six of 50 cases were IgA nephropathy. (5)There was only 1 case of 50 diagnosed as rapidly progressive glomerulonephritis with positive anti-neutrophil cytoplasmic autoantibody (ANCA) staining. Conclusion The “full-house” immunofluorescent staining is a common manifestation of renal pathology for LN, which is not only demonstrated in LN. HBV-GN might present with “full house”, because hepatitis B virus would cause various sizes of immune complex deposits within the glomeruli. Occasionally the “full house” could be found in the cases of purpura nephritis and IgA nephropathy. In the cases of non-lupus nephritis with “full-house” immunofluorescent staining, a long term follow-up is suggested in order to rule out some possible cases with delayed appearance of autoimmune antibodies and/or delayed onset of systemic lupus erythematosus.
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