中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2014年
2期
85-91
,共7页
管音%李航%罗娜%李超%段琳%李艳%文煜冰%李学旺
管音%李航%囉娜%李超%段琳%李豔%文煜冰%李學旺
관음%리항%라나%리초%단림%리염%문욱빙%리학왕
肾小球肾炎,膜性%狼疮肾炎%荧光抗体技术%IgG亚型
腎小毬腎炎,膜性%狼瘡腎炎%熒光抗體技術%IgG亞型
신소구신염,막성%랑창신염%형광항체기술%IgG아형
Glomerulonephritis,membranous%Lupus nephritis%Fluorescent antibody technique%IgG subclasses
目的 探讨特发性膜性肾病(IMN)和继发性膜性肾病(SMN)肾小球免疫荧光IgG亚型的不同表现,评价免疫荧光法IgG亚型在鉴别特发性膜性肾病和膜性狼疮性肾炎(MLN)中的价值.方法 本研究总结了2011年10月至2012年12月于北京协和医院住院行肾脏穿刺活检术、病理改变符合膜性肾病特点并行免疫荧光IgG亚型染色的病例,对其病理类型及肾小球免疫荧光IgG亚型进行统计,同时就诊断为IMN和MLN的病例进行回顾性分析,比较两组在临床表现和肾小球免疫荧光IgG亚型及补体沉积方面的特点,并从中筛选出不同病理指标,对它们的诊断价值进行评价和比较.结果 (1)共收集病例214例,其中IMN占81％,MLN占14％,后者在SMN中居首位.(2)IMN组IgG1、IgG3和IgG4强度较高,其中IgG4的强度高于其他IgG亚型,且其强度显著高于MLN组(P＜ 0.01)；MLN组IgG1和IgG3强度较高,IgG3强度高于其他IgG亚型,但与IMN组差异无统计学意义.(3)肾小球免疫荧光IgG4的受试者特征工作曲线(ROC)的曲线下面积(AUC)为0.814,以强度1为界值诊断灵敏度为91.8％,特异度为46.7％,以强度2为界值诊断灵敏度为84.2％,特异度为70.0％.IgG4与IgG3强度差值的AUC为0.793,以0为界值诊断灵敏度为91.8％,特异度为66.7％.IgG4阳性且IgG4≥IgG3的诊断灵敏度为88.9％,特异度为70.0％.补体C1q的AUC为0.979,以强度1为界值诊断灵敏度为93.3％,特异度为94.2％.IgG4阳性且C1q阴性的诊断灵敏度为87.7％,特异度为93.3％.结论 (1)经免疫荧光法测定,IMN肾小球以IgG4沉积为主,而MLN以IgG3为主.(2)IgG4强度、IgG4与IgG3强度差值及C1q强度具有较高诊断准确性,IgG4强度还可分别与后两者联合使用,以帮助鉴别IMN与MLN.
目的 探討特髮性膜性腎病(IMN)和繼髮性膜性腎病(SMN)腎小毬免疫熒光IgG亞型的不同錶現,評價免疫熒光法IgG亞型在鑒彆特髮性膜性腎病和膜性狼瘡性腎炎(MLN)中的價值.方法 本研究總結瞭2011年10月至2012年12月于北京協和醫院住院行腎髒穿刺活檢術、病理改變符閤膜性腎病特點併行免疫熒光IgG亞型染色的病例,對其病理類型及腎小毬免疫熒光IgG亞型進行統計,同時就診斷為IMN和MLN的病例進行迴顧性分析,比較兩組在臨床錶現和腎小毬免疫熒光IgG亞型及補體沉積方麵的特點,併從中篩選齣不同病理指標,對它們的診斷價值進行評價和比較.結果 (1)共收集病例214例,其中IMN佔81％,MLN佔14％,後者在SMN中居首位.(2)IMN組IgG1、IgG3和IgG4彊度較高,其中IgG4的彊度高于其他IgG亞型,且其彊度顯著高于MLN組(P＜ 0.01)；MLN組IgG1和IgG3彊度較高,IgG3彊度高于其他IgG亞型,但與IMN組差異無統計學意義.(3)腎小毬免疫熒光IgG4的受試者特徵工作麯線(ROC)的麯線下麵積(AUC)為0.814,以彊度1為界值診斷靈敏度為91.8％,特異度為46.7％,以彊度2為界值診斷靈敏度為84.2％,特異度為70.0％.IgG4與IgG3彊度差值的AUC為0.793,以0為界值診斷靈敏度為91.8％,特異度為66.7％.IgG4暘性且IgG4≥IgG3的診斷靈敏度為88.9％,特異度為70.0％.補體C1q的AUC為0.979,以彊度1為界值診斷靈敏度為93.3％,特異度為94.2％.IgG4暘性且C1q陰性的診斷靈敏度為87.7％,特異度為93.3％.結論 (1)經免疫熒光法測定,IMN腎小毬以IgG4沉積為主,而MLN以IgG3為主.(2)IgG4彊度、IgG4與IgG3彊度差值及C1q彊度具有較高診斷準確性,IgG4彊度還可分彆與後兩者聯閤使用,以幫助鑒彆IMN與MLN.
목적 탐토특발성막성신병(IMN)화계발성막성신병(SMN)신소구면역형광IgG아형적불동표현,평개면역형광법IgG아형재감별특발성막성신병화막성랑창성신염(MLN)중적개치.방법 본연구총결료2011년10월지2012년12월우북경협화의원주원행신장천자활검술、병리개변부합막성신병특점병행면역형광IgG아형염색적병례,대기병리류형급신소구면역형광IgG아형진행통계,동시취진단위IMN화MLN적병례진행회고성분석,비교량조재림상표현화신소구면역형광IgG아형급보체침적방면적특점,병종중사선출불동병리지표,대타문적진단개치진행평개화비교.결과 (1)공수집병례214례,기중IMN점81％,MLN점14％,후자재SMN중거수위.(2)IMN조IgG1、IgG3화IgG4강도교고,기중IgG4적강도고우기타IgG아형,차기강도현저고우MLN조(P＜ 0.01)；MLN조IgG1화IgG3강도교고,IgG3강도고우기타IgG아형,단여IMN조차이무통계학의의.(3)신소구면역형광IgG4적수시자특정공작곡선(ROC)적곡선하면적(AUC)위0.814,이강도1위계치진단령민도위91.8％,특이도위46.7％,이강도2위계치진단령민도위84.2％,특이도위70.0％.IgG4여IgG3강도차치적AUC위0.793,이0위계치진단령민도위91.8％,특이도위66.7％.IgG4양성차IgG4≥IgG3적진단령민도위88.9％,특이도위70.0％.보체C1q적AUC위0.979,이강도1위계치진단령민도위93.3％,특이도위94.2％.IgG4양성차C1q음성적진단령민도위87.7％,특이도위93.3％.결론 (1)경면역형광법측정,IMN신소구이IgG4침적위주,이MLN이IgG3위주.(2)IgG4강도、IgG4여IgG3강도차치급C1q강도구유교고진단준학성,IgG4강도환가분별여후량자연합사용,이방조감별IMN여MLN.
Objective To evaluate the diagnostic accuracy of IgG subclasses in differentiating membranous lupus nephritis (MLN) from idiopathic membranous nephropathy (IMN).Methods A total of 214 patients with membranous nephropathy (MN) who underwent renal biopsy at Peking Union Medical College Hospital from October 2011 to December 2012 were included.All renal biopsy specimens were examined and immunofluorescence staining against IgG1,IgG2,IgG3,IgG4 as well as C3,C1q and C4 were evaluated.Clinical manifestations and pathological features were compared between MLN patients and IMN patients.Diagnostic accuracy of IgG subclasses and complements were evaluated.Results Among all the patients selected in this study,81％ were diagnosed IMN while 14％ were diagnosed MLN.The immunofluorescence staining showed that IgG4 tended to be highly expressed in IMN and its intensity was significantly higher than that in MLN (P ＜ 0.01).The intensity of IgG3 was higher than other subclasses in MLN,The AUC of IgG4 intensity was 0.814 and its sensitivity was 91.8％ and 84.2％,the specificity was 46.7％ and 70.0％,when the cut-off point was 1 and 2 respectively.The AUC of the intensity difference between IgG4 and IgG3 was 0.793 and its sensitivity was 91.8％ and the specificity was 66.7％ when the cut-off point was 0.The sensitivity of IgG4≥ 1 and IgG4≥IgG3 was 88.9％ and the specificity was 70.0％.The AUC of C1q intensity was 0.979 and its sensitivity was 93.3％ and the specificity was 94.2％ when cut-off point was 1.The sensitivity of IgG4≥ 1 and C1q ＜ 1 was 87.7％ and the specificity was 93.3％.Conclusions IgG4 is highly expressed in IMN while IgG3 is highly expressed in MLN by means of immunofluorescence staining.Intensity of IgG4,intensity difference between IgG4 and IgG3 and intensity of C1q are of high diagnostic value in MN.The combination of IgG4 intensity and the latter two markers could be helpful in differentiating MLN from 1MN.
