Glomerular IgG subclasses in idiopathic and malignancy-associated membranous nephropathy.
Glomerular IgG subclasses in idiopathic and malignancy-associated membranous nephropathy.
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DOI：
10.1093/ckj/sfv049
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发表时间：
2015-08
影响因子：
4.6
通讯作者：
Haraldsson B
中科院分区：
文献类型：
--
作者：
Lönnbro-Widgren J;Ebefors K;Mölne J;Nyström J;Haraldsson B
在特发性膜性肾病（MN）中，针对肾小球磷脂酶A2受体（PLA2R）的抗体主要报告为IgG4亚类。然而，在MN的发病机制中，无论是在特发性MN和继发性病例中，不同的IgG亚类的作用仍然不清楚。在这项回顾性研究中，我们检验了这样的假设：MN患者中肾小球IgG 4和PLA 2 R的缺乏表明存在恶性疾病。对69例原发性MN和16例恶性MN患者肾小球IgG亚类和PLA2R的分布进行了研究，随访时间平均为83个月。IgG4和PLA2R的缺失与恶性相关性MN之间存在显著相关性，因此，IgG4在69例特发性MN中的45例（65%）中呈阳性，而在16例恶性相关性MN中仅5例（31%）呈阳性。其他IgG亚类在两组之间没有统计学差异，两组中超过94%的患者存在IgG2阳性。63例特发性MN患者中有35例（56%）和16例恶性相关MN患者中有3例（19%）存在肾小球PLA2R沉积。我们发现，肾小球IgG 4和PLA2R的缺乏是常见的恶性相关MN患者。在我们的材料中，IgG2不能用作潜在恶性疾病的标志物。最后，IgG1和IgG3似乎都不参与MN的发病机制。
In idiopathic membranous nephropathy (MN), antibodies directed towards the glomerular phospholipase A2 receptor (PLA2R) have mainly been reported to be of IgG4 subclass. However, the role of the different IgG subclasses in the pathogenesis of MN, both in idiopathic MN and in secondary cases, is still unclear. In this retrospective study, we test the hypothesis that the absence of glomerular IgG4 and PLA2R in patients with MN indicates malignant disease. The distribution pattern of glomerular IgG subclasses and PLA2R was studied in 69 patients with idiopathic MN and 16 patients with malignancy-associated MN who were followed up for a mean of 83 months. A significant correlation between the absence of IgG4 and PLA2R and malignancy-associated MN was found. Thus, IgG4 was positive in 45 of 69 patients (65%) with idiopathic MN but only in 5 of 16 patients (31%) with malignancy-associated MN. The other IgG subclasses did not differ statistically between the groups, IgG2-positivity being present in more than 94% of patients in both groups. Thirty-five of 63 patients (56%) with idiopathic MN and 3 of 16 (19%) patients with malignancy-associated MN had glomerular deposits of PLA2R. We have found that the absence of glomerular IgG4 and PLA2R is common in patients with malignancy-associated MN. In our material, IgG2 could not be used as a marker of underlying malignant disease. Finally, neither IgG1 nor IgG3 seems to be involved in the pathogenesis of MN.