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,...