作者单位:首都医科大学附属北京安贞医院肾内科，北京100029通信作者:谌贻璞，电子信箱:chen_yipu@medmail．com．cn论著膜性肾病肾小球IgG亚型沉积及磷脂酶A2受体表达的回顾性分析董鸿瑞，王艳艳，王国勤，孙丽君，程虹，谌贻璞DOI:10．7504/nk2014040702中图分类号:Ｒ5文献标志码:A摘要:目的研究特发性膜性肾病(IMN)、狼疮性膜性肾病(LN-MN)及乙型肝炎病毒相关性膜性肾病(HBV-MN)患者肾小球IgG亚型分布及磷脂酶A2受体(PLA2Ｒ)表达情况。方法用免疫荧光和(或)免疫组化染色检查2010年6月至2013年10月北京安贞医院肾内科患者肾小球IgG亚型及PLA2Ｒ。结果(1)77例IMNIgG1、IgG2、IgG3及IgG4的阳性率分别为19.5%、37.7%、46.8%及97.4%，IgG4阳性率显著高于其他亚型(P＜0.01)且免疫荧光强度最强。15例LN-MNIgG1、IgG2、IgG3及IgG4的阳性率分别为73.3%、93.3%、66.7%及6.7%，IgG4阳性率显著低于其他亚型(P＜0.01)。8例HBV-MNIgG1、IgG2、IgG3及IgG4的阳性率分别为12.5%、62.5%、75.0%及12.5%。74例(96.1%)IMNPLA2Ｒ阳性，全部LN-MN及HBV-MN患者PLA2Ｒ阴性。72例(93.5%)IMN同时有IgG4沉积及PLA2Ｒ高表达。结论IMN患者肾小球以IgG4沉积为主同时伴PLA2Ｒ高表达，而LN-MN及HBV-MN则以非IgG4的IgG亚型沉积为主，无PLA2Ｒ高表达。该检查可能有助于IMN与此2种继发性MN鉴别。关键词:膜性肾病;IgG4;磷脂酶A2受体;狼疮性肾炎;乙型肝炎病毒相关性肾病IgGsubclassesandphospholipaseA2receptoringlomerulardepositsofmembranousnephropathy:aretrospectiveanalysis．DONGHong-rui，WANGYan-yan，WANGGuo-qin，SUNLi-jun，CHENGHong，CHENYi-pu．DivisionofNeph-rology，BeijingAnzhenHospital，CapitalMedicalUniversity，Beijing100029，ChinaCorrespondingauthor:CHENYi-pu，E-mail:chen_yipu@medmail．com．cnAbstract:ObjectiveToinvestigatethedifferencesintheIgGsubclassdistributionandphospholipaseA2receptor(PLA2Ｒ)expressioninglomeruliofpatientswithidiopathicmembranousnephropathy(IMN)，lupus-relatedMN(LN-MN)andhepatitisB-associatedMN(HBV-MN)．MethodsThepatientsincludedinthisstudywerecollectedfromourhospitalbetweenJune2010andOctober2013.TheIgGsubclassesandPLA2Ｒinglomeruliofthepatientswereexaminedbyimmunofluorescenceand/orimmunohistochemicalstaining．ＲesultsSeventy-sevenpatientswithIMN，15withLN-MNand8withHBV-MNwereenrolled．InIMNpatients，thedepositionfrequenciesofIgG1，IgG2，IgG3andIgG4were19.5%，37.7%，46.8%and97.4%，respectively．IgG4frequencywasthehighest(P＜0.01)anditsimmunofluorescenceintensitywasalsothemoststrongamongthefourIgGsubclasses．ThedepositionfrequenciesofIgG1，IgG2，IgG3andIgG4inLN-MNwere73.3%，93.3%，66.7%and6.7%，respectively．IgG4frequencywasthelowestinthefourIgGsubclasses(P＜0.01)．ThedepositionfrequenciesofIgG1，IgG2，IgG3andIgG4inHBV-MNwere12.5%，62.5%，75.0%and12.5%，respectively．EnhancedexpressionofPLA2Ｒinglomeruliwasfoundin96.1%patientswithIMN，butnotinpatientswithLN-MNorHBV-MN．In93.5%patientswithIMN，IgG4depositionandPLA2Ｒhighexpressionoccurredsimultaneouslyinglomeruli．ConclusionInIMNpatients，IgG4isthepredominantdepositinglomeruli，whichisoftenaccompaniedwithen-hancedPLA2Ｒexpression．However，InLN-MNandHBV-MNpatients，theotherIgGsubclassesexceptforIgG4arepre-dominantdepositsinglomeruli，andnoenhancedPLA2Ｒexpressionisfound．ThisexaminationmayhelptomakedifferentialdiagnosisbetweenIMNandtheabovetwokindsofsecondaryMN．Keywords:membranousnephropathy;IgG4;phospholipaseA2receptor;lupusnephritis;hepatitisB-associatednephropathy7052014年5月第34卷第5期中国实用内科杂志膜性肾病(MN)是肾小球疾病常见的病理类型，占成年人肾病综合征的20%～25%［1－2］。虽然大多数MN为特发性MN(IMN)，但仍有20%～25%为继发性MN，...
