27例成人微小病变型肾病综合征患者高IgE血症临床意义探讨.docVIP

27例成人微小病变型肾病综合征患者高IgE血症的临床意义探讨 　　[摘要] 目的 探讨微小病变型肾病综合征患者中合并高IgE血症的临床意义。 方法 回顾性分析2014年1月～2016年4月衢州市人民医院收治的27例经肾活检病理明确诊断为微小病变型肾病综合征（MCNS）患者，归纳其血IgE血症水平、临床特征及预后情况，同时比较同期收治的成人肾病综合征其他常见病理类型（IgA肾病97例，膜性肾病45例），综合以上数据进行相关研究。 结果 不同病理类型的肾病综合征患者起病时IgE水平有较大差异，其中微小病变组的血IgE平均水平明显增高，而且IgE升高患者所占比例亦明显增高，微小病变组与IgA组或膜性肾病组组间比较差异显著（P均0.05）。随后根据起病时血IgE水平的高低，对27例MCNS患者进行临床特点的比较，发现IgE水平升高者对激素治疗反应时间亦有所延长，且激素减量过程中出现疾病反复的可能性增大。此外，没有一例MCNS患者临床中观察到过敏现象。 结论 MCNS中合并高IgE血症较为突出，且IgE水平的高低可能成为预测疾病预后的一个指标。MCNS患者中高IgE血症的形成机制并不与过敏等原因直接相关，很可能是某种潜在的免疫系统紊乱同时促使肾病、过敏症及高IgE血症的发生。 　　[关键词] 免疫球蛋白E；微小病变型肾病综合征；过敏症；白介素-13 　　[中图分类号] R692.3 [文献标识码] B [文章编号] 1673-9701（2016）36-0048-04 　　[Abstract] Objective To investigate the clinical significance of IgE in patients with minimal change nephrotic syndrome. Methods 27 cases diagnosed with minimal changes in nephrotic syndrome （MCNS） by renal biopsy pathology admitted in our hospital from January 2014 to April 2016 were retrospectively analyzed. The level of blood IgE， clinical features and prognosis were summarized. And other common pathological types of adult nephrotic syndrome in the same period were compared， including 97 cases of IgA nephropathy， 45 cases of membranous nephropathy. The above data were comprehensively studied. Results IgE levels were significantly different when onset in patients with nephrotic syndrome of different pathologic types. The IgE level of patients in minimal change group was significantly higher，and the proportion of increased IgE was significantly higher. There was significant difference between minimal disease group and IgA group or membranous nephropathy group（P0.05）. And then clinical features in 27 cases of MCNS patients were compared according to the blood IgE levels at onset. Response time to hormone therapy in patients with elevated IgE levels seemed to be prolonged， and the possibility of repeated disease increased in the process of hormone reduction. In addition， there was no case of MCNS in patients with clinical observation