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作者报告一例女性患者,54岁时患脊椎变性关节炎。62岁时血压高,尿蛋白少于1克/24小时。乃予甲基多巴降压。65岁患指关节炎,及能自然消失的剧烈胸痛。血压310/170毫米汞柱,尿蛋白17克/24小时;血尿30.000/分(十二小时尿沉淀计数);肌酐清除率35毫升/分。血清IgG0.18克/100毫升(正常1.17±0.27);IgM1.7克/100毫升(正常0.12±0.05);C3补体0.05克/100毫升(正常0.14±0.02);有大量混合性IgG-IgM冷球蛋白。乳胶试验3~+,山羊红细胞凝集试验1:1,024。骨片示关节炎;作了肾活检并与血清在体外的冷沉淀物对比研究。经速尿、可乐定与苯丁酸氮芥治疗半年后尿蛋白0.17克/24小时,血尿消失,血中免疫球蛋白回复正常浓度。又8个月后血压150/90毫米汞柱,无蛋白尿,C3补体0.04克/100毫升。再次行肾活检。此后患者遇冷后一直没有任何症状。冷沉淀物的免疫化学研究发现有IgG与IgM存在。IgM有抗IgG的抗体活性。IgM对以IgG致敏之乳胶颗粒的凝集现象极为清晰。肾活检标本在普通显微镜下呈毛细血管内增殖性肾小球肾炎。毛细血管袢
The authors report a female patient who suffered from vertebral degeneration arthritis at 54 years of age. 62-year-old high blood pressure, urinary protein less than 1 g / 24 hours. Is to step down methyldopa. 65-year-old suffering from arthritis, and severe natural chest pain disappeared. Blood pressure 310/170 mm Hg, proteinuria 17 g / 24 hours; hematuria 30.000 / min (12-hour urine sediment count); creatinine clearance 35 ml / min. Serum IgG 0.18 g / 100 ml (normal 1.17 ± 0.27); IgM 1.7 g / 100 ml (normal 0.12 ± 0.05); C3 complement 0.05 g / 100 ml (normal 0.14 ± 0.02); a large amount of mixed IgG-IgM Cold globulin. Latex test 3 ~ +, goat hemagglutination test 1: 1,024. Bone showed arthritis; made a kidney biopsy and serum in vitro deposition of cryoprecipitate. After furosemide, clonidine and chlorambucil six months after treatment of urinary protein 0.17 g / 24 hours, hematuria disappeared, the blood immunoglobulin returned to normal concentrations. Another eight months after the blood pressure 150/90 mm Hg, proteinuria, C3 complement 0.04 g / 100 ml. Renal biopsy again. Since then the patient has been cold without any symptoms. Immune chemistry studies of cryoprecipitate revealed the presence of IgG and IgM. IgM has anti-IgG antibody activity. Agglutination of IgM-sensitized latex particles is extremely clear. Renal biopsy specimens showed capillary proliferative glomerulonephritis under a normal microscope. Capillaries 袢