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目的探讨特发性膜性肾病(IMN)患者血清中小麦蛋白抗体的水平变化及意义。方法运用液氮研磨丙酮提取法粗提取小麦总蛋白,以此蛋白作为抗原,采用ELISA双抗体间接法检测40例IMN患者(IMN组)、34例其他肾小球肾炎患者(其他肾炎组)和40例健康人(对照组)血清中小麦蛋白特异性抗体IgG、IgA和IgE水平,并对患者进行食物过敏情况问卷调查,观察小麦蛋白特异抗体水平明显变化患者的临床特征。结果 IMN组血清中小麦蛋白特异性IgG水平低于对照组(P<0.01)、其他肾炎组(P<0.05);其他肾炎组与对照组比较,P﹥0.05;各组血清中小麦蛋白特异性IgA水平比较,P>0.05;各组血清中均未检测到小麦蛋白特异性IgE。与其他肾炎组比较,IMN组血清肌酐、24 h尿蛋白定量升高,血浆白蛋白降低(P均<0.05);两组e GFR比较,P﹥0.05。20例血清中小麦蛋白特异性IgG抗体水平明显降低(低于中位数)的IMN患者中12例尿蛋白大于5 g/24 h,且血清白蛋白水平<20.0 g/L。结论 IMN患者血清中小麦蛋白特异性IgG升高,IgA、IgE无变化,IgG可能与IMN发生、发展有关。
Objective To investigate the changes and significance of serum protein in patients with idiopathic membranous nephropathy (IMN). Methods The total protein of wheat was crudely extracted by liquid nitrogen and acetone extraction. The proteins were used as antigen. The IMN group (IMN group), 34 patients with other glomerulonephritis (other nephritis group) The serum levels of IgG, IgA and IgE were detected in 40 healthy volunteers (control group). The food allergy questionnaire was used to observe the clinical features of patients with significant changes in the level of wheat specific protein antibody. Results The level of wheat protein in serum of IMN group was lower than that in control group (P <0.01) and other nephritis groups (P <0.05), while the other nephritis groups were higher than those in control group (P> 0.05) IgA levels, P> 0.05; wheat serum protein-specific IgE was not detected in each group. Compared with other glomerulonephritis groups, serum creatinine and 24 h urinary protein in IMN group increased quantitatively and plasma albumin decreased (P <0.05) Twelve patients with significantly lower (less than median) urinary protein levels were found to have urinary protein levels greater than 5 g / 24 h and serum albumin levels <20.0 g / L. Conclusion The protein of specific IgG in the serum of patients with IMN is elevated, while IgA and IgE are not changed. IgG may be related to the occurrence and development of IMN.