贵州医科大学学报

2020, v.45;No.234(03) 356-362

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IgA型PIGN患者的肾组织病理学特点和治疗效果及预后
The Renal Histopathological Features,Therapeutic Effect and Prognosis of Patients with IgA PIGN

郭永力;穆永芳;管仁苹;滑丽美;
GUO Yongli;MU Yongfang;GUAN Renping;HUA Limei;Department of Nephrology,the First Hospital of Qinhuangdao;Department of Emergency,Qinhuangdao First Hospital;Department of Nutrition,Bethune International Peace Hospital;

摘要(Abstract):

目的:探讨IgA型感染后相关性肾小球肾炎(PIGN)患者的肾组织病理学特点、治疗效果及预后。方法:急性期(22例)及亚急性期(78例)IgA型PIGN患者共100例,对其对症治疗;收集患者肾组织病理切片,采用苏木精-伊红(HE)染色、过碘酸雪夫(PAS)染色、六胺银(PASM)-Masson染色及醋酸铀-柠檬酸铅双染色4种染色方法光镜、电镜观察肾组织的病理学改变,免疫荧光检测IgG、IgA、IgM、C3和C1q表达,随访患者治疗1个月后的治疗效果并采用多因素Logistic回归分析患者预后的危险因素。结果:光镜结果显示,急性期和亚急性期患者肾组织切片上皮侧嗜复红物、间质纤维化、间质炎症细胞浸润及间质水肿,差异有统计学意义(P<0.05);电镜检查显示,83例患者肾组织切片可见巨大上皮下沉积物(驼峰),急性期患者表现更加明显;免疫荧光检查显示,IgG染色强度弱于IgA和C3,强于IgM和C1q,差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,年龄≥60岁、合并基础疾病、血尿及间质纤维化均是影响IgA型PIGN患者预后的危险因素(P<0.05)。结论:IgA型PIGN的肾组织病理学表现多样,年龄≥60岁、合并基础疾病、血尿及间质纤维化患者的治疗效果较差。
Objective: To study the renal histopathological features,therapeutic effect and prognosis of patients with IgA nephropathy post infection related glomerulonephritis( PIGN). Methods: A total of 100 patients with IgA PIGN in acute stage( 22 cases) and subacute stage( 78 cases) were selected;the pathological changes of renal tissue were observed by hematoxylin eosin( HE),periodate Schiff( PAS),silver hexamine( PASM)-Masson and uranyl acetate-lead citrate double staining methods with light and electron microscopy; the expression of IgG, IgA, IgM, C3 and C1q were tested by immunofluorescence. The therapeutic effect of 1 month after treatment was recorded by follow-up,and the multiple Logistic regression was used to analyze the risk factors of patients' prognosis. Results:The results of light microscopy showed that there were significant differences in the positive detection results of eosinophils,interstitial fibrosis,interstitial inflammatory cell infiltration and interstitial edema between the acute and subacute stages,differences were statistically significant( P < 0. 05); the electron microscopy showed that 83 patients had huge subepithelial deposits( humps) in renal histological observation,especially in the acute stage; the immunofluorescence test showed that IgG staining intensity was weaker than IgA and C3,but stronger than IgM and C1q,and the difference were statistically significant( P < 0. 05); the multivariate Logistic regression analysis showed that for people over or at 60 years old,combined with basic diseases,hematuria and interstitial fibrosis were all risk factors for the prognosis of Ig A PIGN patients( P < 0. 05). Conclusion: The renal histopathological manifestations of IgA PIGN are various. The therapeutic outcome is worse in the patients over or at 60 years old,combined with basic diseases,hematuria and interstitial fibrosis.

关键词(KeyWords): 治疗效果;预后;IgA型肾病;感染后相关性肾小球肾炎;肾组织病理;单因素分析
treatment outcome;prognosis;IgA nephropathy;postinfectious glomerulonephritis;renal histopathology;univariate analysis

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基金项目(Foundation): 河北省医学科学研究项目(20150387)

作者(Author): 郭永力;穆永芳;管仁苹;滑丽美;
GUO Yongli;MU Yongfang;GUAN Renping;HUA Limei;Department of Nephrology,the First Hospital of Qinhuangdao;Department of Emergency,Qinhuangdao First Hospital;Department of Nutrition,Bethune International Peace Hospital;

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DOI: 10.19367/j.cnki.1000-2707.2020.03.021

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