肥大细胞和嗜酸性阳离子蛋白在过敏性紫癜性肾炎发病中的作用

目的探讨嗜酸性粒细胞和肥大细胞在过敏性紫癜性肾炎(HSPN)的发生发展中的作用。方法用荧光酶标法测定46例过敏性紫癜性肾炎(HSPN)患儿血清嗜酸性阳离子蛋白(ECP)水平;采用免疫酶组织化学技术检测32例过敏性紫癜性肾炎患儿肾组织中类胰蛋白酶表达细胞(肥大细胞)的数量和分布情况,并分析其与肾脏病变程度之间的关系。结果①HSPN活动期血清ECP水平为(16.3±6.5)μg/L,显著高于正常对照组[(3.1±1.7)μg/L(P<0.01)]和治疗缓解组[(3.9±1.4)μg/L(P<0.01)];首次发作时患儿血清ECP水平为(23.0±8.7)μg/L,明显高于治疗后复发组ECP水平[(9.3±2.2)μg/L(P<0.01)];而缓解组和对照组比较差异无统计学意义(P>0.05)。②免疫组化结果显示正常肾组织中极少有肥大细胞,定数为(4.4±2.4)个/mm2,而过敏性紫癜性肾炎患儿肾间质中浸润肥大细胞显著增多,且随肾脏病理损害程度的加重而更加明显,肾脏病理分级Ⅱ级患儿肾组织中肥大细胞为(27.2±19.2)个/mm2,Ⅲ级为(42.1±16.4)个/mm2,Ⅳ级为(77.9±15.0)个/mm2,过敏性紫癜性肾炎各组与对照组比较、Ⅳ级与Ⅲ级比较、Ⅲ级与Ⅱ级比较差异均有统计学意义。结论ECP水平反映了过敏性紫癜性肾炎的活动情况,肾脏病变与肾间质中肥大细胞浸润程度相平行,嗜酸性粒细胞和肥大细胞在HSPN发生和发展中起了重要作用。

Role of mast cells and eosinophil cationic protein in the pathogenesis of Henoch-Schonlein purpura nephritis

OBJECTIVE: Mast cells and eosinophil have been found to play important roles not only in the development of anaphylactic inflammation but also in the chronic progression of organ reconstruction. But their role in the pathogenesis of Henoch-Schonlein purpura nephritis (HSPN) has not been fully understood. The present study was conducted to observe the serum levels of eosinophil cationic protein (ECP) and renal infiltration of mast cells in HSPN in order to elucidate their role in the development and progression of HSPN in children. METHODS: The serum ECP levels were determined in 46 children with HSPN by fluoro-enzyme immunoassay (FEIA) using the Pharmacia CAP System. The distribution of mast cells infiltration was detected by immuno-enzyme-histological staining of tryptase (a marker for mast cell activation) and their relation with pathological changes was analyzed in 32 children with HSPN. RESULTS: The serum ECP levels were 16.3 +/- 6.5 microg/L in the active stage of HSPN, significantly higher than that in remission stage (3.9 +/- 1.4 microg/L, P < 0.01) and that in control group (3.1 +/- 1.7 microg/L, P < 0.01). The number of mast cells in renal interstitium was 4.4 +/- 2.4 cells/mm2 in normal kidney, and significantly increased to 27.2 +/- 19.2 cells/mm2 in children with HSPN ISKDC grade II (P < 0.01) and 42.1 +/- 16.4 cells/mm2 in grade III (P < 0.05 when compared with grade II), 77.9 +/- 15.0 cells/mm2 in grade IV (P < 0.05 when compared with grade III). CONCLUSION: The serum ECP level could reflect disease activity of HSPN, and mast cell infiltration in kidney correlated significantly with renal histological severity in HSPN. Mast cells and eosinophil may play important roles in the development and progression of HSPN.