IgA肾病患者黏膜免疫系统情况的临床调查

Clinical investigation of mucosal immune system in IgA nephropathy patients

关键词:  IgA肾病  黏膜免疫  血尿

Key words:  IgA nephropathy  mucosa immune system  hematuria

摘要:

目的　了解IgA肾病患者的黏膜免疫系统受累情况。方法　收集122例IgA肾病患者的临床资料，观察黏膜炎症的部位及其与临床表现的关系，了解其黏膜系统受累情况。结果　122例患者中，男50例，女72例，年龄19～62岁，平均（37.4±15.6）岁，病程1～199个月，平均（29.6±10.3）个月。临床表现为单纯蛋白尿43例（35.2%），单纯血尿28例（23.0%），血尿合并蛋白尿51例（41.8%），肾功能不全者39例（32.0%）。122例中慢性咽炎76例（62.3%），慢性肠炎43例（35.2%），慢性扁桃体炎40 例（32.8%）；本组中有1项黏膜炎症者28例（23.0%），2项黏膜炎症者55例（45.1%），3 项及3 项以上黏膜炎症者68例（55.7%），10例(8.2%)无明显黏膜炎症。有血尿患者中慢性咽炎、慢性扁桃体炎、慢性肠炎、牙周炎的发病率明显高于无血尿患者(P<0.05)，而慢性鼻炎、慢性胃炎、尿路感染的发病率在两组患者中比较无明显差异(P>0.05)。结论　本研究中91.8%的IgA 肾病患者存在黏膜免疫异常，提示从调节黏膜免疫着手寻找可能的治疗靶点，将为IgA 肾病的防治提供新思路。

Abstract:

Objective　To investigate the involvement of mucosal immune system in IgA nephropathy patients.Methods　In this study, we analyzed the clinical data of 122 IgA nephropathy patients, including the location of mucosal inflammation and the correlation with clinical manifestations, in order to know the situation of affected mucosal immune system.Results　Of all the 122 patients (males, 50; females, 72), the mean age was (37.4±15.6) years (range, 19 to 62 years), with a mean course of (29.6±10.3) months (range, 1 to 199 months). 28 (23.0%) patients presented with pure hematuria, 43 (35.2%) with proteinuria alone, and 51 (41.8%) with concomitant hematuria and proteinuria. Meanwhile, 39 (32.0%) patients had renal insufficiency. Among the 122 patients, 76（62.3%）had chronic pharyngitis, 43（35.2%）had chronic enteritis, and 40（32.8%）had chronic tonsillitis. In addition, 28（23.0%）patients had one, 55（45.1%）had two, 68（55.7%）had three, and 10 (8.2%) had no inflammation. Compared with the patients without hematuria, the prevalence of chronic pharyngitis, chronic enteritis, chronic tonsillitis and periodontitis were more frequent in the patients with hematuria (P<0.05). In contrast, the prevalence of chronic rhinitis, chronic gastritis and urinary tract infection did not exhibit statistical difference between patients with and without hematuria (P>0.05).Conclusions　About 91.8% of IgA nephropathy patients have mucosal immune abnormalities, suggesting potential therapeutic targets by adjusting mucosal immune system, which may provide new insights for the treatment of IgA nephropathy.