IgA肾病和非IgA系膜增殖性肾小球肾炎抗内皮细胞抗体的检测

对１２７例ＩｇＡ肾病（ＩｇＡＮ）患者和２５例非ＩｇＡ系膜增殖性肾炎血清进行了抗内皮细胞抗体ＡＥＣＡ的检测。结果表明：ＩｇＡ肾病患者和非ＩｇＡ系膜增殖性肾炎患者血清ＡＥＣＡ－ＩｇＧ较正常对照组高，而ＩｇＡＮ患者较非ＩｇＡ系膜增殖性肾炎患者ＡＥＣＡ－ＩｇＧ的水平高，Ｐ〈０．０５。ＩｇＡＮ患者的ＡＥＣＡ－ＩｇＡ水平较正常对照组高。ＩｇＡＮ患者按ＡＥＣＡ水平分为阳性与阴性组，对两组硬化面积比进行比较，未见     

抗肾小球基底膜抗体在各类肾小球疾病中的检测及其致病性研究

抗肾小球基底膜抗体在各类肾小球疾病中的检测及其致病性研究吕红，郭怡清，吴长龙，江世益，钟慈声，杨俊华ＴＨＥＤＥＴＥＲＭＩＮＡＴＩＯＮＡＮＤＲＥＳＥＡＲＣＨＯＦＡＮＴＩＢＯＢＹＯＦＡＮＴＩＧＢＭＯＮＤＩＦＦＥＲＥＮＴＧＬＯＭＥＲＵＬＡＲＤＩＳＥＡＳＥＬ...     

Synaptopodin在肾小球疾病中表达的研究进展

synaptopodin是肾小球足细胞分化成熟的标志,在维持足细胞的正常形态及功能方面发挥着重要作用,其突变或缺失可导致足细胞结构的改变,并影响到肾小球滤过膜的通透性增高,引起临床蛋白尿,对肾小球疾病的发展及预后产生重要影响.研究synaptopodin在肾小球疾病中的表达变化,对研究足细胞损伤在肾小球疾病发生发展中的作用机制具有重要意义,对肾小球疾病的治疗提供新的切入点.本文将结合当前synaptopodin的研究进展作一综述.     

抗肾小球基底膜抗体疾病的临床表现及诊断

抗肾小球基底膜（glomerular basement membrane, GBM）抗体相关疾病是指在循环或脏器中沉积了抗GBM抗体的一组临床疾病。最早是南Emest Goodpasture于1919年发现,他报道了1例18岁的患者表现为咯血、坏死及增生性肾炎,直到1967年抗GBM抗体方被识别。这类疾病的根本特征是组织基膜和血清内存在抗基膜抗体并伴有。肾、肺、中枢神经、眼底、皮肤及血液等系统性损伤。因此,统称这类疾病为抗GBM抗体疾病,其肾脏损伤为抗GBM肾炎。     

应用抗肾小球基底膜抗体的中和性单克隆抗体治疗抗肾小球基底膜肾炎大鼠的实验研究

目的 应用抗肾小球基底膜（GBM）抗体的中和性单克隆抗体注射抗GBM肾炎大鼠,观察各种生化指标及肾脏病理学的变化。 方法 将Wistar大鼠随机分为5组,每组9只：(1)肾炎模型组：经尾静脉注入人抗GBM抗体;(2)正常对照Ⅰ组:经尾静脉注入非抗体性的健康人lgG;(3)对照Ⅱ组：经尾静脉注入抗GBM抗体的中和性单克隆抗体;(4)干预Ⅰ组：经尾静脉注入人抗GBM抗体,第7天后再经尾静脉注入抗GBM抗体的中和性单克隆抗体(1.5 ml/100 g);(5)干预Ⅱ组：经尾静脉注入人抗GBM抗体,第14天后再经尾静脉注入抗GBM抗体的中和性单克隆抗体。分别在实验后第7、14、21天观察大鼠24 h尿蛋白量、BUN、Scr和肾组织病理学的变化。 结果 第21天干预Ⅰ组尿蛋白量为（16.62±5.53） g/d、BUN为（11.53±2.26） mmol/L、Scr为（102.46±16.86） μmol/L,均显著低于肾炎模型组（P < 0.05）;干预Ⅱ组较肾炎模型组也有所降低,但差异无统计学意义（P > 0.05）。干预Ⅰ组和干预Ⅱ组肾脏细胞增生、新月体的形成及免疫复合物的沉积均少于肾炎模型组,但干预I组更为明显。对照Ⅰ组和对照Ⅱ组之间无明显变化。 结论 早期应用抗GBM抗体的中和性单克隆抗体能够有效改善抗GBM肾炎大鼠的肾脏病变。     

狼疮性肾炎中抗内皮细胞抗体和抗心磷脂抗体的关系

目的 进一步探讨狼疮性肾炎（ＬＮ）中抗内皮细胞抗体（ＡＥＣＡ）和抗心磷脂抗体（ＡＣＡ）的关系。方法 采用ＥＬＩＳＡ方法对５８例ＬＮ患者血清进行了ＡＥＣＡ和ＡＣＡ检测，并应用免疫印迹方法对ＡＥＣＡ的抗原进行分析。结果 在狼疮性肾炎中ＡＥＣＡ与ＡＣＡ阳性率分别为３６．２％和３９．７％，在２３例ＡＣＡ阳性患者中，１７例ＡＥＣＡ阳性，而３５例ＡＣＡ阴性患者中只有４例ＡＥＣＡ阳性，两者比较具有显著性差异（Ｐ     

血浆置换治疗抗肾小球基膜抗体肾炎1例

病例 患者,女40岁,因排肉眼血尿10 d,恶心、乏力1周于2001年10月9日入院.入院前10 d无诱因排肉眼血尿,为全程血尿,初为浓茶样,渐呈鲜红色,每次约200 ml,5～6次/d,间有腰痛,呈阵发性,1周前出现恶心,全身乏力,偶有四肢抽搐.     

抗内皮细胞抗体在过敏性紫癜肾炎患儿中的表达及临床意义

目的 检测过敏性紫癜肾炎（HSPN）患儿血清的抗内皮细胞抗体（AECA）的表达情况,探讨AECA在HSPN发生发展中的作用.方法 过敏性紫癜患儿（HSP）60例,按有无肾脏累及分为HSPN组（40例）和无肾累及（NO-HSPN）组（20例）,正常对照组20例.应用酶联免疫吸附（ELISA）法检测血清AECA水平,进行比较,并分析其与预后的关系.结果 HSPN组和NO-HSPN组的血清AECA水平[分别为（369.66±59.20）ng/ml、（328.09±57.97）ng/ml]均高于对照组（232.31±53.89）ng/ml（P＜0.01）,HSPN组的血清AECA水平高于NO-HSPN组（P＜0.05）.HSPN患儿中血清AECA水平随蛋白尿水平增加而逐渐增加,24 h尿蛋白0.2～1.0 g组显著高于24 h尿蛋白〈0.2 g组,同时低于24 h尿蛋白〉1.0 g组,差异有统计学意义（P＜0.01）.肉眼血尿组的血清AECA水平高于无血尿组,与镜下血尿组比较差异无统计学意义（P〉0.05）;镜下血尿组的血清AECA水平高于无血尿组（P＜0.01）.AECA水平与HSPN的预后呈显著性相关（Spearman等级相关分析,rs=0.600,P＜0.01）.结论 AECA可能参与了HSPN的发生、发展过程,血清AECA水平能反映HSPN患儿的预后,提示AECA可作为判断HSPN病情的一个指标.     

原发性肾小球疾病治疗新进展

随着肾活检率的提高和对肾小球疾病病因学认识的不断深人，治疗方法也有了发展。本文综述了近年国外治疗各类肾小球疾病方法上的一些新进展。     

Anti-neutrophil cytoplasmic antibodies and anti-endothelial cell antibodies

Anti-netrophil cytosolic antibodies (ANCA) and anti-endothelial cell antibodies (AECA) have been identified in a wide variety of disorders, but their pathophysiological role remains unclear. ANCA appear to be particularly associated with various forms of vasculitis including Wegener's granulomatosis, Kawasaki disease and microscopic polyartiritis. Cytoplasmic staining (cANCA) on indirect immunofluorescence is associated with extrarenal disease and a perinuclear pattern (pANCA) with renal limited disease. The cANCA antigen appears to be proteinase 3 and that for pANCA myeloperoxidase. AECA have been detected in systemic lupus erythematosus, scleroderma and dermatomyositis but are also found in systemic vasculiitis. Kawasaki disease, haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura and renal allograft recipients at the time of rejection. Their presence appears to be correlated with disease activity and they may be directed against epitopes on as yet unidentified infective agents that precipitate some of the diseases in which they are found that cross-react with antigenic sites exposed on endothelial cells. Measurement of these antibodies has a diagnostic role, facilitates monitoring of disease activity and may prove valuable in understanding the pathogenesis of the diseases in which they are found.     

血清IgG4检测在膜性肾病诊断及鉴别诊断中的意义

目的 分析血清IgG4水平对原发性膜性肾病(IMN)诊断及其与继发性膜性肾病(SMN)患者诊断和鉴别诊断的意义.方法 检测28例膜性肾病患者(其中IMN 21例,SMN 7例)血清IgG4水平,并行尿蛋白测定及相关血生化检测,对其结果进行分析比较.结果 IMN组和SMN组血清IgG4水平(分别为2373.86 ng/L±1156.59 ng/L和1321.57 ng/L±1330.28 ng/L)比较有显著性差异(P＜0.01),两组尿蛋白定量(分别为6.46 g/d±6.41 g/d和5.74 g/d±3.53 g/d)比较无显著性差异(P＞0.05),而两组主要血生化指标比较也无显著差异(P＞0.05).结论 血清IgG4水平检测可作为临床IMN的诊断及其与SMN鉴别诊断的指标之一.     

肾移植受者术前测定抗HLA-IgG抗体的临床意义

目的　研究肾移植受者术前抗HLA IgG抗体水平的临床意义。 方法　采用酶联免疫吸附法 (ELISA)检测 184例肾移植受者术前抗HLA IgG抗体水平。分析抗HLA IgGI类抗体、Ⅱ类抗体阳性与急性排斥反应发生的关系。结果　肾移植受者术前抗HLA IgG抗体阴性者 15 5例 ,其中18例发生排斥反应 ,发生率 11.6 % ;抗HLA IgGⅠ类抗体阳性者 7例 ,2例发生排斥反应 ,发生率2 8.5 7% ;抗HLA IgGⅡ类抗体阳性者 9例 ,4例发生排斥反应 ,发生率4 4 .4 4 % ;Ⅰ类抗体、Ⅱ类抗体均阳性者 13例 ,8例发生排斥反应 ,发生率 6 1.5 3% ,与阴性对照组比较 ,差异有显著性 (P <0 .0 0 1)。结论　肾移植受者术前抗HLA IgG抗体阳性与术后排斥反应发生率密切相关 ,提示术前检测抗HLA IgG抗体具有重要的临床意义 ,可以预测排斥反应及指导治疗。     

Immunological characterization of anti-endothelial cell antibodies induced by cytomegalovirus infection

BACKGROUND: We have previously shown that the levels of anti-endothelial cell antibodies (AECA) determined by an enzyme immunoassay are elevated during cytomegalovirus (CMV) infection in cardiac and renal transplant recipients. In a separate study, high levels of AECA are associated with higher frequency of humoral allograft rejection (AR), chronic AR and lower 2 year allograft survival in cardiac transplant recipients. These results suggests that high levels of AECA produced during CMV infection may have a pathogenic role or be a risk factor for humoral AR, chronic AR and decreased allograft survival. Here we examined the reactivity of AECA against endothelial cells and other tissues to further characterize AECA induced by CMV infection. METHODS: Sodium dodecyl sulfate-polyacrylamide gel electrophoresis/Western blot analysis was performed. RESULTS: The number and intensity of bands reactive with human umbilical vein ECs (HUVECs) increased during and after CMV infection. AECA(+) plasma reacted with multiple antigens expressed not only on endothelial cells but also on human fibroblasts, keratinocytes, platelets (PLs), peripheral blood mononuclear cells (PBMCs), Raji cells and THP-1 cells. Each individual's AECA(+) plasma showed different patterns of reactivity against these cells, whereas each plasma showed similar patterns of reactivity against ECs, PLs or peripheral blood mononuclear cells obtained from different individuals. AECA(+) plasma also showed a similar pattern of reactivity against HUVECs pretreated with/without interferon-gamma/tumor necrosis factor-alpha. The reactivity of preabsorbed sera with PLs significantly decreased against most reactive antigens expressed on PLs and other cell types. CONCLUSIONS: (1) Antibodies induced by CMV infection are not specific to endothelial cells and appear to react with multiple cell types, (2) AECA (+) plasma react with multiple antigens expressed on various cell types that are primarily constitutively expressed on these cells and are not individual specific, (3) CMV-induced antibodies in AECA (+) plasma are primarily autoantibodies. These results suggest that the elevated AECA levels seen in CMV-infected transplant recipients may represent a polyclonal activation of humoral immune responses induced by CMV, which is of uncertain pathogenic significance.     

抗HLA和抗MICA抗体的表达对移植肾功能和急性排斥反应的预示作用

目的 探讨抗HLA与抗主要组织相容性复合物Ⅰ类链相关基因A(MICA)抗体的表达对移植肾功能和急性排斥反应的预示作用.方法 采用免疫磁珠流式液相芯片技术检测41例肾移植受者移植前后的抗HLA和抗MICA抗体,其中37例接受了1、3、6个月及1、2、3年的动态随访.分析抗HLA和抗MICA抗体的特异性,及其与血清肌酐和排斥反应的相关性.结果 移植前共有9例(22.0%,9/41)预存抗HLA或(和)抗MICA抗体,其巾抗HLA抗体阳性2例(4.9%,2/41),抗MICA抗体阳性6例(14.6%,6/41),抗HLA和抗MICA抗体均阳性1例(2.4%,1/41).另外有5例抗MICA抗体可疑阳性.除1例的抗MICA抗体为供者特异性抗体(DSA)外,其余均为非供者特异性抗体(NDSA).37例随访者中,6例新生抗HLA抗体(16.2%),3例新生抗MICA抗体(8.1%),新生抗HLA抗体者的抗体滴度在随访3年中呈现上升趋势.9例预存抗体的受者,有4例(44.4%,4/9)发生排斥反应;6例新生抗HLA抗体的受者中,有3例(50.0%)发生急性排斥反应,而3例新生抗MICA抗体的受者均无排斥反应发生,二者间的差异有统计学意义(P＜0.05).新生抗HLA抗体产生较早(术后3 d和7 d)的2例受者均检测到抗HLAⅡ类DSA,其移植肾均因排斥反应而切除.预存抗MICA抗体,且移植后发生排斥反应者在随访的每个时间点上的血清肌酐水平均高于预存抗MICA抗体但无排斥反应者(P＜0.05);移植前抗HLA和抗MICA抗体均阴性者,术后发生排斥反应者在随访的每个时间点上的血清肌酐水平均高于抗体阴性且无排斥反应者(P＜0.01);无论是新生抗HLA抗体还是抗MICA抗体,移植后1个月发生排斥反应者的血肌酐均明显高于抗体阴性且无排斥反应者(P＜0.01).结论 预存和新生抗HLA抗体是移植后发生急性排斥反应的重要因素,而供、受者HLA和MICA基因错配是产生新生抗体的重要原因.     

小儿肾包虫囊肿的诊断及治疗

蚴病的主要方法.手术方法为肾部分切除、外囊大部切除、内囊摘除术.     

Identification of anti-endothelial cell antibodies in patients with chronic anal fissure.

BACKGROUND: Recent studies demonstrate that chronic anal fissure can be the consequence of a local ischemic process. Thus hypothesizing that at the perianal level the interaction of immune component with endothelium could constitute a mechanism determining ischemia and hypertonia, the presence or absence of circulating anti-endothelial cell antibodies (AECAs) was determined in the serum of patients with anal fissure. METHODS: The study was carried out on 30 patients: 10 with posterior chronic anal fissure (group 1), 10 with grades III and IV hemorrhoids (group 2), and 10 without previous or active anorectal disease, or both (group 3). An indirect immunofluorescence assay on sections of rat kidney tissue was used to identify AECA in the peripheral blood. RESULTS: The assay result was positive for AECAs in 12 patients, all with anorectal disease when compared to the control group (P = .001). The basal anal tone was higher in the AECA-positive patients than in the AECA-negative patients (P = .001). CONCLUSIONS: Only the patients with anal fissure or hemorrhoids were AECA positive. All healthy controls tested negative for AECA. Although the number of subjects studied is small, the presence of auto-antibodies directed against the endothelial cells in the serum of these patients supports the hypothesis that the endothelium is involved in the anal disease.     

Little evidence for anti-endothelial cell antibodies in microscopic polyarteritis and Wegener's granulomatosis

We studied sera from patients with vasculitis and controls forthe presence of anti-endothelial cell antibodies (AECA) andcorrelated these with disease type, anti-neutrophil cytoplasmicantibodies (ANCA) and anti-myeloperoxidase (MPO) antibodies.AECA were detected by a cellular ELISA on cultured human umbilicalvein endothelium. AECA were found in the sera of one of 43 patientswith microscopic polyarteritis (2%), five of 27 patients withWegener's granulomatosis (19%), three of 23 patients with anidiopathic glom-erulonephritis (13%), none of eight patientswith rheumatoid arthritis and three of 12 patients with rheumatoidvasculitis (25%). In patients with a vasculitis AECA titreswere higher in sera with a positive ANCA as compared with ANCAnegative sera although the difference was not significant (P= 0.0702) and there was no correlation between AECA and anti-MPOtitres (r = 0.1171 P=0.114). AECA binding was not enhanced followingupregulation of endothelial ICAM-1 and ELAM-1 by TNF. This studyshows that AECA occur infrequently in microscopic polyarteritisand Wegener's granulomatosis, and are not a major antibody systemin these vasculitides.     

肾移植受者术前血清抗血管内皮细胞抗体与急性排斥反应的关系

目的 研究肾移植受者术前血清抗内皮细胞抗体（AECA）的水平对术后6个月内发生急性排斥（AR）的预测作用。 方法 将1998年12月至2003年8月在本中心行同种异体肾移植并存有血标本的495例受者纳入研究。回顾总结术后6个月内AR发生情况及相关资料。健康对照（阴性对照）40例。采用细胞-ELISA法,以EA.hy926细胞（人脐静脉内皮细胞株）为底物检测血清AECA水平。结果采用比值表示,P（患者）/N（阴性对照）=（A患者标本-A空白对照）/（A阴性对照-A空白对照）。P/N大于健康对照组均值加2个标准差者为阳性。 结果 495例患者血清中,AECA阳性93例（18.8%）。维持血透时间大于12个月患者血清AECA水平（1.43±0.37）显著高于未透析患者（1.27±0.32,P = 0.013）及维持血透时间≤12个月患者（1.31±0.32,P = 0.029）。血清AECA水平与透析时间呈正相关（r = 0.218,P = 0.018）。AECA阴性、阳性患者术后6个月内AR发生率分别为23.4%、38.7%,差异有统计学意义（P = 0.002）。AECA阳性患者细胞性AR、体液性AR的发生率均显著升高（P = 0.035,P = 0.002）。多元Logistic回归分析显示AECA阳性、群体反应性抗体（PRA）≥10%、高淋巴毒反应为发生AR的独立危险因素,优势比（OR）分别为2.056、1.751、1.764（P值分别为0.004、0.029、0.050）。 结论 肾移植受者术前血清AECA阳性预示术后发生急性排斥反应的风险增加。术前血清AECA水平随透析时间延长而升高。     

不同尿蛋白检测在肾脏疾病中的临床观察及诊断价值

目的 探讨尿微量白蛋白(mALB)、尿转铁蛋白(TRF)、尿胱蛋白酶抑制剂C(Cystatin C)、尿β2-微球蛋白(β2 - MG)、尿免疫球蛋白IgG(IgG)检测在肾脏疾病中的敏感性及临床价值.方法 选择2011年3月～2011年8月在新疆维吾尔自治区人民医院肾病科住院的肾脏疾病患者50例作为病例组,健康体检者30例为对照组.采用酶联免疫法(ELISA)检测尿mALB、TRF、Cystatin C、β2 - MG及IgG的含量,并以ROC曲线分析其敏感性.结果 病例组患者尿mALB、TRF、Cystatin C、β2 - MG及IgG的测定浓度明显高于对照组,差异具有统计学意义(P ＜0.001),通过ROC曲线、诊断试验结果显示:尿β2 - MG、mALB、TRF、IgG、Cystatin C曲线下面积为0.998、0.950、0.950、0.919、0.833,95％可信区间分别为0.001～1.000、0.904～0.997、0.894～1.000、0.851 ～0.987,0.739～0.927.尿β2 - MG、mALB、TRF较尿IgG、Cystatin C更具有敏感性(P ＜0.001).结论 尿β2 - MG、mALB、TRF、IgG及Cystatin C联合检测可作为肾损害性疾病的敏感指标,对延缓肾脏疾病的进展具有重要的临床意义.