抗肾小球基膜病合并 IgA 肾病或膜性肾病的临床病理特征分析

doi:10.3969/cndt.j.issn.1006-298X.2018.02.003

肾脏病与透析肾移植杂志 ›› 2018, Vol. 27 ›› Issue (2): 113-118.DOI: 10.3969/cndt.j.issn.1006-298X.2018.02.003

抗肾小球基膜病合并 IgA 肾病或膜性肾病的临床病理特征分析

出版日期:2018-04-28 发布日期:2018-05-02

Antiglomerular basement membrane disease combined with IgA nephropathy or membranous nephropathy

Online:2018-04-28 Published:2018-05-02

摘要/Abstract

摘要：

目的：探讨抗肾小球基膜（GBM）病合并 IgA 肾病（IgAN）或膜性肾病（MN）患者的的临床病理特征及预后特点。
方法：选取2004年1月~2015年12月于南京总医院国家肾脏疾病临床医学研究中心经肾活检确定为抗 GBM 病合并 IgAN 患者（合并 IgAN 组）10例，抗 GBM 病合并 MN 患者（合并 MN 组）5例，与60例单纯抗 GBM 病患者（单纯抗 GBM病组）比较，分析三组患者在临床表现、肾活检病理特征及预后的差异。
结果：与单纯抗GBM病组相比，合并IgAN组、合并MN组患者出现无尿者较少，蛋白尿和镜下血尿较多，抗GBM抗体滴度较低，但均无统计学差异。单纯抗GBM病组患者肾损伤程度较重，临床表现为急进性肾炎综合征（RPGN）的比例明显增高（P=0004），高血压比例高(P=0002),血肌酐峰值最高（P<0001），且贫血程度重（P<0001）。单纯抗GBM病组患者总新月体比例高（P=0008）且包囊壁断裂比例亦高（P=0005）。单纯抗 GBM组患者需连续肾脏替代治疗比例最高（P=0008）。单纯抗GBM病组患者1年内进展至终末期肾病比例最高（P<0001）。
结论：合并IgAN或MN的抗GBM病在临床表现、实验室检查、病理指标及预后均不同于单纯抗GBM病。

关键词: 抗肾小球基膜病, IgA肾病, 膜性肾病, 新月体肾炎

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To investigated the differences in clinical characteristics，pathological features and prognosis of antiglomerular basement membrane (GBM) disease combined with IgA nephropathy or membranous nephropathy.
Ｍｅｔｈｏｄｏｌｏｇｙ：From January 2004 to December 2015, seventy five patients with antiGBM disease were enrolled into this retrospective study. According to the pathological diagnosis, the patients were divided into three group, including 10 cases of antiGBM disease with IgA nephropathy (with IgAN group), 5 cases of antiGBM disease with membranous nephropathy (with MN group) and 60 cases of simple antiGBM disease (simple antiGBM disease group). The clinical, laboratory and pathological indices were compared among the three groups.
Ｒｅｓｕｌｔｓ：In patients of antiGBM disease with IgAN group and with MN group, they had lower percents of anuria, while more urine protein and microscope hematuria, and a lower level of antiGBM antibodies, but not statistical significance. Furthermore, the patients in simple antiGBM disease group were more serious in renal dysfunctions, which represented as highest percents of rapidly progressive glomerulonephritis (RPGN) (P=0004), highest levels of hypertension (P=0002), serum creatinine (SCr,P<0001) and a more serious degree of anemia (P<0001). In pathology, the patients in simple antiGBM disease group were observed to have the highest percentage of crescents in glomeruli (P=0008) and Bowmans wall fracture (P=0005). In the course of treatment, the patients in simple antiGBM disease group had the highest proportion of continuous renal replacement therapy（P=0008）. During the followup, the patients in simple antiGBM disease group had the highest percentage of end stage renal disease (ESRD) in one years (P<0001）.
Ｃｏｎｃｌｕｓｉｏｎ：
AntiGBM disease with IgA nephropathy or membranous nephropathy is different from simple antiGBM disease in clinical manifestations, laboratory indices, pathology and prognosis.

Key words: anti-glomerular basement membrane disease, IgA nephropathy, membranous nephropathy, crescentic glomerulonephritis

张帆，童玲，高二志，等. 抗肾小球基膜病合并 IgA 肾病或膜性肾病的临床病理特征分析[J]. 肾脏病与透析肾移植杂志, 2018, 27(2): 113-118.

ZHANG fan，TONG ling，GAO erzhi，et al. Antiglomerular basement membrane disease combined with IgA nephropathy or membranous nephropathy[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2018, 27(2): 113-118.

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[3]	徐峰,曾彩虹. IgA肾病合并急性肾盂肾炎[J]. 肾脏病与透析肾移植杂志, 2020, 29(1): 88-92.
[4]	林佳群，方丽碧，张小红，等. 青年特发性膜性肾病临床病理特征[J]. 肾脏病与透析肾移植杂志, 2019, 28(4): 330-335.
[5]	张帆，高二志，王金泉. 非典型抗肾小球基膜病[J]. 肾脏病与透析肾移植杂志, 2019, 28(2): 171-175.
[6]	罗慧婷,梁少姗,梁丹丹,等. 肾小球毛细血管内增生伴巨噬细胞浸润的IgA肾病[J]. 肾脏病与透析肾移植杂志, 2019, 28(1): 1-6.
[7]	王荣，唐政. IgG4相关性肾病的病理改变及特征[J]. 肾脏病与透析肾移植杂志, 2019, 28(1): 73-77.
[8]	张昌明，刘志红. 1型血小板反应蛋白7A域（THSD7A）与膜性肾病[J]. 肾脏病与透析肾移植杂志, 2018, 27(3): 255-259.
[9]	陈梦星，张丽华，刘志红. 利妥昔单抗在特发性膜性肾病治疗中的应用[J]. 肾脏病与透析肾移植杂志, 2018, 27(3): 274-278.
[10]	刘玲玲，徐维玮，刘志红. 环磷酰胺治疗特发性膜性肾病的疗效[J]. 肾脏病与透析肾移植杂志, 2018, 27(2): 182-186.
[11]	尤冰，陈劲松. 肾移植术后IgA肾病复发[J]. 肾脏病与透析肾移植杂志, 2018, 27(1): 84-88.
[12]	杨柳，王金泉. 补体活化异常与IgA肾病[J]. 肾脏病与透析肾移植杂志, 2017, 26(3): 273-276.
[13]	刘蕾，乐伟波，徐孝东，等. 特发性膜性肾病凝血功能障碍与血小板功能亢进的关联[J]. 肾脏病与透析肾移植杂志, 2017, 26(2): 108-112.
[14]	李英. 利妥昔单抗在特发性膜性肾病中的应用[J]. 肾脏病与透析肾移植杂志, 2017, 26(1): 54-55.
[15]	王淑伟,张丝雨,刘楠,等. 膜性肾病合并新月体形成患者的临床及病理分析[J]. 肾脏病与透析肾移植杂志, 2016, 25(5): 415-419.

ISSN 1006-298X CN 32-1425/R

抗肾小球基膜病合并 IgA 肾病或膜性肾病的临床病理特征分析

Antiglomerular basement membrane disease combined with IgA nephropathy or membranous nephropathy

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