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目的研究抗肾小球基底膜(GBM)抗体的亲合力及其与临床病理表现的关系。方法以纯化的牛IV型胶原α链非胶原区1[α(IV)NC1]为靶抗原,采用抗原抑制性酶联免疫吸附法对我科近11年来确诊的52例抗GBM抗体相关疾病患者的血清抗体亲合力进行检测,并分析其与临床和病理表现的关系。结果使52例患者血清抗体百分结合率从相同水平下降50%所需的α(IV)NC1从0·02μg~20μg不等,平均为0·625μg。不同患者血清抗体亲合力与肾脏病理中新月体所占比例相关(P=0·001),且为独立决定因素(R2=0·58,P=0·000)。即抗体亲合力越高,肾小球中新月体的比例越高。发病年龄、性别、临床表现不同的患者,抗体亲合力之间差异无统计学意义(P>0·05)。起病后不同时间检测血清抗体亲合力基本稳定,未见增加。结论起病时抗GBM抗体的亲合力成熟过程已经完成。不同患者之间抗GBM抗体的亲合力存在差异,该亲合力与病理肾脏损伤的程度高度相关,提示抗GBM抗体的亲合力在抗GBM抗体相关疾病的发病机制中起了重要作用。
Objective To study the affinity of anti-glomerular basement membrane (GBM) antibody and its relationship with clinicopathological features. Methods Purified bovine type IV collagen α chain non-collagen 1 [α (IV) NC1] as target antigen, anti-GBM antibody-related diseases Serum antibody affinity test and analysis of its relationship with clinical and pathological findings. Results The α (IV) NC1 required for 52% reduction in serum antibody percentage from the same level was from 0.02μg to 20μg with an average of 0.625μg. The serum antibody affinity of different patients was correlated with the proportion of crescent in renal pathology (P = 0.001), and was an independent determinant (R2 = 0.58, P = 0.000). The higher the affinity of the antibody, the higher the proportion of crescent in the glomerulus. There was no significant difference in antibody affinity between patients with different age, gender and clinical manifestations (P> 0.05). At different times after onset of serum antibody affinity was basically stable, no increase. Conclusion The onset of anti-GBM antibody affinity maturation process has been completed. There is a difference in the avidity of anti-GBM antibodies between different patients, which is highly correlated with the degree of pathological kidney injury, suggesting that the affinity of anti-GBM antibodies plays an important role in the pathogenesis of anti-GBM antibody-related diseases.