The Investigation Of Intestinal Flora And SIgA In The Initial IMN Patients And Its Significance

Objectives:Membranous nephropathy(MN)is the most common etiology of nephrotic syndrome in adults.The disease is characterized by the presence of immune complexes in the subepithelial space of the glomerular filtration barrier.The etiology of idiopathic membranous nephropathy(IMN)is unknown.In our country,the incidence of IMN accounts for 9.54% in all primary glomerular disease.The pathogenesis of IMN is remains unclear,therefore,it is important to explore the pathogenesis of IMN further and it will be helpful to make a clear clinical diagnosis and to guide the treatment.Intestinal flora,SIgA and intestinal mucosal permeability represent the intestinal mucosa barrier,immune barrier and mechanical barrier,respectively.Intestinal mucosa barrier system abnormalities may be involved in the occurrence and development of autoimmune diseases.A study discovered that some patients with childhood membranous nephropathy have cationic bovine serum albumin(BSA).BSA may adsorb through immature intestinal mucosal barrier and lead to MN.Does IMN have intestinal mucosal barrier damage?What is the relationship between intestinal mucosal injury and the pathogenesis of IMN?In this study,we examined the intestinal mucosal bio-barrier and immune barrier by detecting the number of intestinal microflora and the level of secretory immunoglobulin A(SIgA),and discussed its relationship with the pathogenesis of IMN in order to provide scientific for the clinical treatment of IMN Guidance and theoretical basis.Methods:The 51 patients(34 male and 17 female,mean age 46.57±12.88 years,mean BMI 25.30±3.52 kg/m2)with IMN referred to the Third Hospital of Hebei Medical University from May 2016 to December 2016 was named as IMN group.Examination was done by immunofluorescence,light microscopicand electron microscopic examination of renal biopsies.The other 21 healthy examination people(13 male and 8 female,mean age 52.62±14.23 years,mean BMI 24.65±3.01kg/m2)referred to the Third Hospital of Hebei Medical University at the same time was named as healthy control group.All IMN patients had never used hormone and immunosuppressive therapy before participate in this study and onset time in one month.We collected the first fresh feces sample in the morning with an empty stomach.The ratio of the amount of Bifidobacterium/Escherichia coli(B/E)in feces represents the ecotope of intestinal microecology.The decline of B/E ratio indicates the intestinal flora disorder.1 Bifidobacterium,Lactobacillus acidophilus,Escherichia coli and Enterococcus faecalis was examined by real-time PCR to assess intestinal microbe barrier function.2 The levels of SIgA were measured by enzyme-linked immuno sorbent assay(ELISA),which was used to assess intestinal immunological barrier function.3 The correlation between serum albumin and intestinal flora,SIgA and B/E were analyzed in the initial IMN patients.The correlation between urinary protein and intestinal flora,SIgA and B/E were analyzed in the initial IMN patients.The correlation between the number of intestinal microflora,B/E value and SIgA level was analyzed.The data analyzed with SPSS 21.0 statistical software.Measurement data of normal distribution are expressed as mean±standard.Measurement data of skewness distribution are expressed as the median(mix-max).Statistical comparisons of normal distribution data were made using two independent sample t-test and analysis of variance.Statistical comparisons of skewness distribution data were made using the Mann.Whitney U test.Bivariate normal distribution correlation analysis using pearson linear correlation analysis Using the Spearman rank correlation analysis when do not meet the conditions.P<0.05 was considered to have statistical significance.Results:1 Compared with the healthy control group,IMN group decreased the number of Bifidobacterium,Lactobacillus acidophilus,Enterococcus faecalis and decreased B/E.However,there was no significant difference between the two groups(P>0.05).2 Compared with healthy control group,the level of SIgA in feces in IMN group was statistically significant(P<0.05).3 The correlation of the four bacteria,B/E ratio and blood albumin,proteinuria were not observed(P>0.05).The correlation of SIgA and blood albumin,proteinuria were also not observed.(P>0.05).Escherichia coli and SIgA were negatively related(r=-0.344,P=0.013<0.05).B/E ratio and SIgA were positively related(r=0.382,P=0.006<0.05).Conclusion:1 There was no significant intestinal dysbacteriosis in the initial IMN patients.Whether intestinal flora related to IMN directly needs further research.2 The results showed that Escherichia coli in intestinal flora was significantly associated with SIgA,which was statistically different in IMN,indicating that E.coli abnormalities in intestinal flora can cause SIgA abnormalities,and thus participate in the development of IMN.This may be one of the pathogenesis of IMN.3 The correlation of SIgA and blood albumin,proteinuria was also not observed.The former does not reflect the clinical outcome of IMN.We need further research through discussing the correlation of SIgA and renal pathological changes such as basement membrane thickness and the degree of immune complex deposition.