原发性IgA肾病患儿肾组织免疫病理及CD44的表达

目的:探讨细胞表面糖蛋白(CD44)在儿童IgA肾病(IgAN)发病中的作用及其与肾小管间质损害的关系。方法:46例IgAN患儿按临床表现分为3组:孤立性血尿组14例,血尿蛋白尿组17例,肾病综合征组15例;按病理分级分为3组:病理Ⅰ+Ⅱ级组23例,Ⅲ级组14例,Ⅳ级组9例。设肾活检正常对照组4例。采用免疫组化SP法检测病例组与对照组肾组织CD44的表达,并分析其与肾小管间质病变程度的相关性。结果:①正常肾组织仅有少量CD44表达。②IgAN患儿肾组织中CD44的表达均较对照组明显增高,不同临床表现组中肾病综合征组最高,孤立性血尿组最低,且与IgAN患儿的病理分级密切相关。③IgAN患儿肾组织CD44的表达与肾小管间质损害程度呈正相关。结论:CD44参与了儿童IgAN的发病和肾小管间质损害,与IgAN的进展及预后有关。

Immunopathology of renal tissues and the expression of CD44 in children with IgA nephropathy

Objective:To explore the effect of CD44 on pathogenesis of IgA nephropathy in children and its relationship with tubulointerstitium damage.Methods:46 children with IgA nephropathy were divided into three groups according to clinical manifestations:isolated hematuria group(14 patients),hematuria and proteinuria group(17 patients) and nephrotic syndrome group(15 patients);while they also were divided into gradeⅠ+Ⅱ group(23 patients),gradeⅢ group(14 patients) and gradeⅣ group(9 patients) according to their pathological grades.4 cases with normal results of renal biopsy were selected as control group;the expression levels of CD44 in case group and control group were detected by immunohistochemical method,the correlation between CD44 and severity of tubulointerstitium damage was analyzed.Results:The expression level of CD44 in normal renal tissues was low;the expression level of CD44 in renal tissues of case group was significantly higher than that of control group;the expression level of CD44 in nephrotic syndrome group was the highest,while the expression level of CD44 in isolated hematuria group was the lowest,which was closely related to pathological grades of IgA nephropathy in children;there was a positive correlation between CD44 expression and severity of tubulointerstitium damage in children with IgA nephropathy.Conclusion:CD44 participates in the occurrence of IgA nephropathy and tubulointerstitium damage,which is related to development and prognosis of IgA nephropathy.