原发性系膜增生性肾小球肾炎补体及免疫球蛋白水平分析

摘要

目的 观察原发性系膜增生性肾小球肾炎(mesangialprolifera-tiveglomerulonephritis,MsPGN)患者补体、免疫球蛋白水平的变化,寻找病情评估的可靠指标.方法 选取我院2013年2月—2016年6月经肾活检确诊为原发性MsPGN的90例患者,观察不同性别、不同年龄段、不同24 h尿蛋白定量水平患者血清IgG、IgE、IgM、IgA及补体C3、C4水平,以及补体、免疫球蛋白与24 h尿蛋白定量的相关性.结果 90例原发性MsPGN血清IgM阳性及IgG阳性各79例(87.78%).女性患者IgG、IgM水平较男性患者高,IgE水平低于男性患者,差异均有统计学意义(P<0.05或P<0.01).随患者年龄的增长,IgA水平逐渐升高,IgE水平逐渐降低,差异有统计学意义(P<0.05);IgA在不同24 h尿蛋白定量组间差异有统计学意义,5.0~13.0 g/24 h组IgA水平显著高于其他组(P<0.05),且血清IgA水平与24 h尿蛋白定量呈正相关(r=0.227,P=0.031).结论 通过观察原发性MsPGN患者补体、免疫球蛋白的变化可判断疾病的进展及调整治疗方案,并可经干预细胞免疫水平以改善患者预后.%Objective To observe changes of complement and immunoglobulin levels in patients with primary me-sangial proliferative glomerulonephritis ( MsPGN) in order to look for reliable indicators for condition assessment. Methods A total of 90 patients with primary MsPGN, who were confirmed by renal biopsy examination during February 2013 and June 2016 were recruited in this study, and serum immunoglobulin G ( IgG) , IgE, IgM and IgA and complement C3 and C4 levels in patients with different genders, ages and 24 h urine protein quantitative levels were observed, and correlations between com-plement and immunoglobulin levels with 24 h urine protein quantitative levels. Results Among the 90 patients with primary MsPGN, serum positive IgM and IgG were 79 patients (87. 78%) respectively. In females, IgG and IGM levels were signifi-cantly higher, while IgE level was significantly lower than those in males (P<0. 05 or P<0. 01). With the increasing age of patients, IgG levels were gradually increased, and IgE levels were gradually decreased (P<0. 05). Differences of IgA levels in patients with different 24 h urine protein quantitative levels groups were statistically significant (P<0. 05), and IgA level in patients with 5. 0-13. 0 g/24 h urine protein quantitative level was significantly higher than those in patients with other 24 h urine protein quantitative levels ( P<0. 05 ) , and the serum IgA level was positively correlated with the 24 h urine protein quantitative level (r=0. 227, P=0. 031). Conclusion Progress and adjustment treatment of the disease can be determined by observing changes of complement and immunoglobulin levels in patients with primary MsPGN, and cellular immunity level can be interfered in order to improve prognosis of patients.