| 成易兰,张璐,王玉娟,等.累及肾脏的单克隆免疫球蛋白病临床病理特征及肾脏预后[J].安徽医药,2025,29(9):1819-1823. |
| 累及肾脏的单克隆免疫球蛋白病临床病理特征及肾脏预后 |
| Clinicopathological features and prognosis of monoclonal gammopathy with renal involvement |
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| DOI：10.3969/j.issn.1009-6469.2025.09.025 |
| 中文关键词: 单克隆免疫球蛋白沉积病 肾损伤 临床病理特征 预后 |
| 英文关键词: Monoclonal immunoglobulin deposition disease Renal injury Clinicopathological features Prognosis |
| 基金项目:国家自然科学基金( 82270711；81800614) |
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| 中文摘要: |
| 目的分析累及肾脏的单克隆免疫球蛋白病( MG)的临床病理特征及肾脏预后。方法收集 2018年 1月至 2022年 12月在武汉大学人民医院经肾活检确诊的 49例累及肾脏的单克隆免疫球蛋白病病人临床病理资料及预后资料。按照临床及病理结果分为免疫球蛋白相关淀粉样变性组及非淀粉样变性组，对比分析免疫球蛋白相关淀粉样变性病人的临床特征及肾脏预后。结果 49例累及肾脏的单克隆免疫球蛋白病病人的发病年龄为( 62.2±7.6)岁，大多数是男性( 37例， 75.5%)主要表现为蛋白尿、血尿及双下肢水肿。高脂血症、高血压病、糖尿病、心血管病及低蛋白血症病人分别占总人群的 83.7%，34.7，%，14.3%，34.7%及 79.6%。肾脏病理类型有免疫球蛋白相关淀粉样变性( 35例， 57.1%)、管型肾病( 6例， 12.2%)、单克隆免疫球蛋白沉积病(6例， 12.2%)及单克隆免疫球蛋白相关 C3肾小球肾炎(2例， 4.1%)。免疫球蛋白相关淀粉样变性病人轻链 λ型(28例， 80%)更常见，蛋白尿( P=0.193)更严重，高血压病( P=0.016)的比例更低。治疗后病人的肾脏预后较好( P=0.039)。结论累及肾脏的单克隆免疫球蛋白病病人多为老年男性，合并基础疾病，最常见的病理类型是免疫球蛋白相关淀粉样变性。治疗有助于改善累及肾脏的单克隆免疫球蛋白病病人肾脏预后。 |
| 英文摘要: |
| Objective To analyze the clinicopathological features and renal prognosis of patients with monoclonal gammopathy (MG). Methods The clinicopathological and prognostic data of 49 MG patients with renal involvement diagnosed by renal biopsy in RenminHospital of Wuhan University from January 2018 to December 2022 were collected. According to the clinicopathological results, the pa-tients were assigned into immunoglobulin-associated amyloidosis (AL amyloidosis) group and non-AL amyloidosis group. The clinical features and prognosis of patients of AL amyloidosis were analyzed.Results Among the 49 MG patients with renal involvement, themean age was (62.2±7.6) years old. Most of the patients were male (37, 75.5%) and the main manifestations were proteinuria, hematuria and edema of both lower limbs. The proportions of patients with hyperlipidemia, hypertension, diabetes, cardiovascular disease and hy-poproteinemia were 83.7%, 34.7%, 14.3%, 34.7% and 79.6%, respectively. The pathological types of renal diseases were AL amyloido-sis (35, 57.1%), cast nephropathy (6, 12.2%), monoclonal immunoglobulin deposition disease (6, 12.2%) and C3 glomerulopathy withmonoclonal gammopathy (2, 4.1%). In AL amyloidosis patients, λ light chain (28, 80%) was more common, proteinuria (P=0.193) was severer, and the proportion of hypertension (P=0.016) was lower. Renal prognosis was significantly improved after treatment (P=0.039). Conclusions The patients of monoclonal gammopathy with renal involvement were mostly elderly males with underlying diseases.The most prevalent pathological type was immunoglobulin-associated amyloidosis. Treatment can improve renal prognosis in patients with monoclonal gammopathy with renal involvement. |
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