The Immunopathological Spectrum of Crescentic Glomerulonephritis: A Survey of 106 Patients in a Single Chinese Center
The Immunopathological Spectrum of Crescentic Glomerulonephritis: A Survey of 106 Patients in a Single Chinese Center
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新月体肾小球肾炎的免疫病理学谱：对中国单个中心 106 名患者的调查
DOI：
10.1159/000314665
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发表时间：
2010-01-01
影响因子：
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通讯作者：
Zhao, Ming-Hui
中科院分区：
文献类型：
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作者：
Lin, Wei;Chen, Min;Zhao, Ming-Hui
背景：新月体肾小球肾炎（CrGN）是一种严重的肾小球损伤.我们回顾性分析了我们中心中国CrGN患者的数据，以描述CrGN的免疫病理学谱。方法：共招募了106例经活检证实的CrGN患者。根据免疫荧光显微镜检查结果将CrGN分为3型; I型定义为免疫球蛋白沿肾小球基底膜（GBM）沿着线性沉积，II型定义为免疫复合物的肾小球沉积，III型定义为缺乏免疫沉积。结果：106例患者中17例（16.0%）为I型，43例（40.6%）为II型，46例（43.4%）为III型。血清抗中性粒细胞胞浆抗体（ANCA）阳性率分别为I型1/17（5.9%）、II型11/43（25.6%）和III型29/46（63.0%）（p < 0.001）。17例Ⅰ型患者中14例（82.4%）、43例Ⅱ型患者中2例（4.7%）、46例Ⅲ型患者中3例（6.5%）血清中抗GBM抗体阳性。在II型CrGN中，ANCA阳性患者比ANCA阴性患者年龄更大（p < 0.001），多系统受累（p < 0.001）和肾组织病理学纤维素样坏死更多（p = 0.003）。结论：缺免疫性CrGN可能是我国北方CrGN的最常见类型。每种类型的CrGN内存在很大的异质性。
Background: Crescentic glomerulonephritis (CrGN) is a severe form of glomerular injury. We retrospectively analyzed data from Chinese patients with CrGN in our center to characterize the immunopathological spectrum of CrGN. Methods: A total of 106 consecutive patients with biopsy-proven CrGN were recruited. CrGN was classified into 3 types according to findings on immunofluorescence microscopy; type I was defined as a linear deposition of immunoglobulins along the glomerular basement membrane (GBM), type II as a glomerular deposition of immune-complex and type III as a pauci-immune deposition. Results: A total of 17/106 (16.0%) patients were classified as type I, 43/106 (40.6%) as type II and 46/106 (43.4%) as type III. Serum antineutrophil cytoplasmic antibodies (ANCA) could be detected in 1/17 (5.9%) patient with type I, 11/43 (25.6%) patients with type II and 29/46 (63.0%) patients with type III CrGN (p < 0.001). Serum anti-GBM antibodies could be detected in 14/17 (82.4%) patients with type I, 2/43 (4.7%) patients with type II and 3/46 (6.5%) patients with type III. In type II CrGN, ANCA-positive patients were older (p < 0.001), had more multi-system involvement (p < 0.001) and more fibrinoid necrosis in renal histopathology than ANCA-negative patients (p = 0.003). Conclusions: Pauci-immune CrGN might be the most common type of CrGN in Northern China. There was much heterogeneity within each type of CrGN.