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目的探讨IgA肾病患者伴系膜区IgG沉积与单纯IgA沉积间临床及病理之间的关系。方法收集自2009年11月~2016年2月于南方医科大学第三附属医院肾活检诊断为IgA肾病患者122例。所有肾活检样本均行光镜、免疫荧光和电镜检查。根据患者免疫荧光结果系膜区有无IgG沉积,将IgA肾病患者分为单纯IgA沉积组(n=63)与IgA-IgG沉积组(n=59)。对所有患者进行Lee分级及牛津分级。对比两组临床及病理差异。结果 IgA肾病伴IgG沉积组临床血肌酐、24小时尿蛋白、血尿酸、甘油三酯水平均高于单纯IgA沉积组(P<0.05);eGFR低于单纯IgA沉积组(P<0.001);病理中有更多的患者处于Lee氏分级IV-V级、肾小管萎缩或/和间质纤维化评分及MEST评分≥3比例多(P<0.05)。结论 IgA肾病系膜区伴IgG沉积患者临床及病理较重,应加强对IgA肾病系膜区伴IgG沉积的认识,延缓IgA肾病的进展。
Objective To investigate the relationship between the IgA nephropathy patients with mesangial deposition of IgG and IgA deposition between the clinical and pathological. Methods Totally 122 patients with IgA nephropathy diagnosed by renal biopsy in the Third Affiliated Hospital of Southern Medical University from November 2009 to February 2016 were collected. All kidney biopsies were examined by light microscopy, immunofluorescence and electron microscopy. Patients with IgA nephropathy were divided into simple IgA deposition group (n = 63) and IgA-IgG deposition group (n = 59) according to immunofluorescence results. Lee and Oxford grading were performed on all patients. Compare the two groups of clinical and pathological differences. Results The levels of serum creatinine, 24-hour urinary protein, serum uric acid and triglyceride in patients with IgA nephropathy and IgG deposition were higher than those in IgA alone group (P <0.05), eGFR was lower than those in IgA alone group (P <0.001) More patients were in Lee’s Grade IV-V class with more tubular atrophy or / and interstitial fibrosis scores with MEST scores ≥ 3 (P <0.05). Conclusion IgA nephropathy with deposition of IgG in patients with severe clinical and pathological, IgA nephropathy should strengthen the understanding of the deposition of mesangial area with IgG, delay the progression of IgA nephropathy.