干燥综合征肾脏损害的临床、病理及机制研究

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1、上海交通大学硕士学位论文干燥综合征肾脏损害的临床、病理及机制研究姓名：任红申请学位级别：硕士专业：临床医学内科学（肾脏病学）指导教师：陈楠20070501功能恢复正常18例。高IgG组患者dRTA的发生率、肾小管性蛋白尿发生比例显著高于正常IgG组（P＜0.05）；血IgG水平与血钾浓度呈显著负相关（R=-0.269，P＜0.01）；高IgG与正常IgG组相比，尿β2-MG、NAG、RBP升高，浓缩稀释功能异常比例、血BUN都较正常IgG组有增高趋势，MDRD有下降趋势,但两组无统计学差异；血BUN与IgG水平呈显著正相关，（R=0.42，P＜0.01）；高IgG组以肾小管性蛋白尿为主，正常

2、IgG组以肾小球性蛋白尿为主，两组间存在显著性差异（P＜0.05）；正常IgG组患者低补体发生率显著高于高IgG组（P＜0.05）；两组患者肾组织的肾小管间质积分（TI）和肾小球积分（GI）比较无统计学差异。免疫荧光结果显示：在肾小管间质区和肾小球浸润的炎细胞中都有BlyS的表达。pSS患者中BlyS表达均高于正常对照组，正常IgG组患者肾组织BlyS表达高于高IgG组（P=0.03）。结论：pSS合并肾脏损害常见，以肾小管功能障碍为突出表现，肾脏病理改变的严重性与肾功能的损害程度存在明显相关性，必要的激素和免疫抑制剂治疗可逆转肾功能改善预后。高丙种球蛋白血症与dRTA之间存在一定的相关性，

3、临床上对于高丙种球蛋白血症患者要注意检查小管酸化功能。BlyS不仅表达在肾小管间质浸润的炎性细胞表面，而且在肾小球炎细胞中也有表达，而且血IgG的水平影响了肾脏组织中BlyS的表达水平。关键词：干燥综合征，肾脏损害，临床病理，高丙种球蛋白，人B细胞激活因子RENALINVOLVEMENTINSJÖGRENSYNDROME:CLINICALCHARACTERISTICS,PATHOLOGICALFEATURESANDPATHOGENESISSTUDYABSTRACTObjectives:Toidentifytheclinicalcharacteristics,pathologicalchang

4、es,thecorrelationanalysisofhypergammaglobulin(hyper-IgG)andrenalinvolvementofthepatientswithprimarySjögrensyndrome(pSS).TodetecttheexpressionofBlymphocytestimulator(BlyS)inrenalbiopsiedsectionsandanalysisthedifferenceoftheexpressionofBlySbetweenpatientswithhypergammaglobulinandnormalgammaglobulinle

5、vel.Methods:AllthepatientswithpSSandrenalinvolvementwhowereadmittedtoourrenaldepartmentinRuijinhospitalfromApril1993toDecember2006werecollected.Allthedataofclinicalfeaturesandpathologicalchangeswereretrospectivelyanalyzed.OnewayANOVAandSpearsoncorrelationanalysiswereusedforthecomparisonofpatientswi

6、thorwithouthypergammaglobulinonclinicalcharacteristics,renaltubularinjuries，glomerularlesions,renalfailure,immunologytestsandrenalpathologicalchanges.41patientswithpSSwereunderwentrenalbiopsies.TheexpressionofBlySintherenaltissuesweredetectedbyimmunofluorescence.Results:130pSScaseswereinvolvedinthe

7、studyincluding8malesand122females.Theageofthepatientsrangedfrom16to68yearswithanaverageof44.1±11.52years.95patients(73.1%)developedrenaltubularacidosis(RTA).Amongthese95RTApatients,91patientswerefoundtohave