| 邓文超,郭鹏,杨伟鹏,等.伴免疫球蛋白G 沉积原发性膜性肾病病人疾病缓解影响因素及与肾小球免疫球蛋白G4 表达强度的关系研究[J].安徽医药,2023,27(3):515-519. |
| 伴免疫球蛋白G 沉积原发性膜性肾病病人疾病缓解影响因素及与肾小球免疫球蛋白G4 表达强度的关系研究 |
| Influencing factors for disease remission and its relationship with glomerular IgG4 expression in PMN patients with IgG deposition |
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| DOI：10.3969/j.issn.1009-6469.2023.03.020 |
| 中文关键词: 肾小球肾炎，膜性 蛋白尿 受体，磷脂酶A2 免疫球蛋白G 疾病缓解 性别 |
| 英文关键词: Glomerulonephritis, membranous Proteinuria Receptors, phospholipase A2 IgG Disease remission Gender |
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| 中文摘要: |
| 目的 探讨伴免疫球蛋白(Ig)G沉积原发性膜性肾病(PMN)病人疾病缓解影响因素及与肾小球IgG4表达强度的关系。方法 回顾性纳入山西省运城市中心医院2014年1月至2020年1月收治伴IgG沉积PMN病人共500例，根据有无IgG4表达和表达强度分组，分析临床病理及随访预后资料，采用单因素和多因素Cox回归模型评价伴IgG沉积PMN病人疾病缓解独立影响因素。结果 阳性组24 h尿蛋白量和M型磷脂酶A2受体(PLA2R)表达强度比例显著高于阴性组(P<0.05)；弱阳性组、中阳性组及强阳性组血浆白蛋白、IgG1强度比例及IgA强度比例比较差异有统计学意义(P<0.05)；阴性组、弱阳性组、中阳性组及强阳性组随访3个月( 30.0%比17.3%比15.9%比9.5%)和6个月(38.4%比30.6%比26.5%比13.0%)累积缓解率比较差异有统计学意义(P<0.05)；Cox回归模型单因素和多因素分析结果显示，IgG4阳性高强度、男性、基线高24 h尿蛋白量均是伴IgG沉积PMN病人疾病未缓解独立危险因素［RR=1.33，95%CI:(1.05，1.61)；RR=1.80，95%CI:(1.17，3.04)；RR=1.51，95%CI:(1.09，2.80)。P<0.05］。结论 伴IgG沉积PMN病人疾病缓解效果与IgG4表达强度、性别及基线24 h尿蛋白量密切相关；而肾小球IgG4表达强度可作为PMN治疗反应性潜在评估指标加以应用。 |
| 英文摘要: |
| Objective To investigate the influencing factors for disease remission and its relationship with glomerular IgG4 expres?sion in primary membranous nephropathy (PMN) patients with IgG deposition.Methods A total of 500 PMN patients with IgG deposi?tion, who were admitted to Shanxi Yuncheng Central Hospital from January 2014 to January 2020, were retrospectively included in the study and grouped according to the presence or absence of IgG4 expression and expression intensity. The clinicopathological and fol?low-up prognostic data were analyzed and univariate and multivariate Cox regression models were used to evaluate the independent in?fluencing factors of disease remission in PMN patients with IgG deposition.Results The proportion of 24 h urinary protein and M-type phospholipase A2 receptor (PLA2R) expression intensity in positive group was significantly higher than negative group(P<0.05). There was significant difference in the intensity ratio of plasma ALB, IgG1 and IgA among weak positive group, medium positive group and strong positive group (P<0.05). There were significant differences in cumulative remission rates with follow-up for 3 and 6 months among negative group, weak positive group, and medium positive group [cumulative remission rates with follow-up for 3 months:30.0%vs. 17.3% vs. 15.9% vs. 9.5%;cumulative remission rates with follow-up for 6 months:38.4% vs. 30.6% vs. 26.5% vs. 13.0%;P<0.05].Univariate and multivariate analysis of Cox regression model showed that high IgG4-positive intensity, male and high baseline 24 h uri?nary protein were independent risk factors for unresponsive disease in PMN patients with IgG deposition [RR=1.33, 95%CI:(1.05,1.61);RR=1.80, 95%CI:(1.17,3.04); RR=1.51, 95%CI:(1.09,2.80); P<0.05].Conclusion The disease remission effect of PMN patients with IgG deposition was closely related to the expression intensity of IgG4, gender and baseline 24 h urinary protein and the expression in?tensity of IgG4 in glomerulus can be used as the potential evaluation index of PMN treatment response. |
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