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目的通过观察IgG、IgG1和IgG4在膜性肾病(MN)中的表达,分析其在膜性肾病分期中的意义及其鉴别诊断价值。方法收集经肾穿刺活检病理(免疫荧光、光镜、电镜)确诊的144例膜性肾病,对其进行免疫组化IgG亚型的观察,结合临床资料及病理学特点,进行统计的分析,评价在膜性肾病分期中的鉴别诊断价值。结果(1)144例MN中,MN-I占81.9%,MN-II占16.7%,MN-III占1.4%。IgG亚型在各期MN中的分布:MN-I期中,IgG阳性率最高(98.3%),其次为IgG4(86.4%),IgG和IgG4阳性率显著高于IgG1(49.2%),差异显著(P<0.05)。(2)MN-II期中,IgG阳性率最高(100%),其次为IgG4(87.5%),IgG阳性率显著高于IgG1(70.8%),差异显著(P<0.05)。(3)MN-III期中,IgG及IgG1阳性率最高(均为100%),其次为IgG4(50%),IgG和IgG1阳性率显著高于IgG4,差异显著(P<0.05)。结论 (1)经免疫组化方法测定,MN-I期中以IgG沉积为主,MN-II期中以IgG和IgG4沉积为主,MN-III期中以IgG和IgG1沉积为主。(2)IgG、IgG1和IgG4在膜性肾病中具有较高的阳性一致率,有助于各期膜性肾病的鉴别诊断。
Objective To observe the expression of IgG, IgG1 and IgG4 in membranous nephropathy (MN) and analyze its significance in the differential diagnosis of membranous nephropathy. Methods 144 cases of membranous nephropathy diagnosed by renal biopsy (immunofluorescence, light microscopy and electron microscopy) were collected. Immunohistochemical IgG subtypes were observed and analyzed according to clinical data and pathological features. Statistical analysis and evaluation In the differential diagnosis of membranous nephropathy. Results (1) Among 144 MN patients, MN-I accounted for 81.9%, MN-II accounted for 16.7% and MN-III accounted for 1.4%. The distribution of IgG subtypes in each stage of MN was highest (98.3%) in the MN-I stage, followed by IgG4 (86.4%), the positive rates of IgG and IgG4 were significantly higher than those in IgG1 (49.2%) P <0.05). (2) In the MN-II phase, the positive rate of IgG was the highest (100%), followed by IgG4 (87.5%), the positive rate of IgG was significantly higher than that of IgG1 (70.8%) (P <0.05). (3) The positive rates of IgG and IgG1 were highest in MN-III stage (both 100%), followed by IgG4 (50%), the positive rates of IgG and IgG1 were significantly higher than those of IgG4 (P <0.05). Conclusions (1) Immunohistochemical analysis showed that IgG was mainly present in MN-I phase, mainly in IgG and IgG4 phase in MN-II phase, and mainly IgG and IgG1 in MN-III phase. (2) IgG, IgG1 and IgG4 in membranous nephropathy have a higher positive consistency rate, contribute to the differential diagnosis of membranous nephropathy.