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探讨狼疮肾炎(lupus nephritis,LN)患者血清IgG4水平和肾脏IgG4沉积情况与疾病活动指标的相关性,初步明确IgG4在LN发病中的作用,为LN的防治提供新的线索。入组LN患者146例(WHO分型包括II型18例,IV型86例,V型9例,V+IV型33例),并以70例正常人为对照;酶联免疫吸附试验(ELISA)检测血清IgG4水平,并分析其与临床指标(血肌酐、总胆固醇、血尿素氮、血清白蛋白、血尿酸和24h尿蛋白等)的相关性;直接免疫荧光法检测LN患者肾脏组织IgG各亚型(IgG1、2、3和4)的沉积情况。结果显示:LN患者血清IgG4水平较正常人显著升高(P<0.05);LN患者血清IgG4水平与血肌酐、总胆固醇和24h尿蛋白定量呈负相关(r=0.24,P<0.05;r=0.35,P<0.05;r=0.28,P<0.05),与血清白蛋白水平呈正相关(r=0.22,P<0.05),但与血尿素氮、血尿酸无相关。IgG及其亚型在LN组织中沉积普遍,以毛细血管壁和系膜区为主。其中IV、V、(V+IV)型IgG1、IgG2和IgG3的沉积强度显著强于II型;V型IgG4沉积强度显著强于IV(P<0.05);IV型LN组织沉积IgG1/IgG4的比值显著高于V型(P<0.05);V型LN组织沉积IgG4/总IgG的比值显著高于IV型(P<0.05)。IgG4在LN的发病中可能起保护作用,有望为LN的防治提供新的策略。
To investigate the relationship between serum IgG4 level and renal IgG4 deposition in patients with lupus nephritis (LN) and the disease activity index, to clarify the role of IgG4 in the pathogenesis of LN and to provide new clues for the prevention and treatment of LN. One hundred and sixty-six patients with LN were enrolled in this study (WHO classification included 18 cases of type II, 86 cases of type IV, 9 cases of type V and 33 cases of type V + IV), and 70 normal controls were used as controls. Enzyme-linked immunosorbent assay (ELISA) Serum IgG4 level was detected and its correlation with clinical indicators (serum creatinine, total cholesterol, blood urea nitrogen, serum albumin, serum uric acid and 24h urinary protein) were analyzed. Direct immunofluorescence assay was used to detect IgG in kidneys of LN patients (IgG1, 2, 3 and 4) deposition. The results showed that the level of serum IgG4 in patients with LN was significantly higher than that in controls (P <0.05). The level of serum IgG4 in patients with LN was negatively correlated with the serum creatinine, total cholesterol and proteinuria in 24 hours (r = 0.24, P <0.05) 0.35, P <0.05; r = 0.28, P <0.05), and had a positive correlation with serum albumin level (r = 0.22, P <0.05), but not with blood urea nitrogen and serum uric acid. IgG and its subtype deposition in LN tissue generally, to the capillary wall and mesangial area based. The deposition intensity of type IV, V, (V + IV) IgG1, IgG2 and IgG3 was significantly stronger than that of type II. The deposition intensity of V type IgG4 was significantly stronger than that of IV (P <0.05) (P <0.05). The ratio of IgG4 / total IgG in V-LN tissue was significantly higher than that in IV type (P <0.05). IgG4 may play a protective role in the pathogenesis of LN and is expected to provide a new strategy for the prevention and treatment of LN.