狼疮性肾炎肾组织凋亡及凋亡相关蛋白Survivin的表达

目的 探讨狼疮性肾炎（LN）肾脏细胞凋亡情况及Survivin是否参与了LN发生发展过程，从而加强LN发病机制的认识。方法用原位末端标记法（TUNEL）检测各型LN患者80例肾组织细胞凋亡；用免疫组化方法检测Survivin在各型LN患者肾组织中的表达。结果Ⅰ型轻微病变型和Ⅵ型硬化型LN肾小球细胞的凋亡发生率均小于1％；而Ⅱ型、Ⅲ型、Ⅳ型、Ⅴ型等增生型LN组织中凋亡的发生率平均在20％以上。凋亡指数AI与蛋白尿之间存在相关关系（r=0．312，P=0．005〈0，05），而与血尿的程度及活动度均无相关关系。Survivin在I型轻微病变型LN及Ⅵ型硬化型LN组织中的表达极为有限，分别为14．3％和33．3％，而在Ⅱ型、Ⅲ型、Ⅳ型、Ⅴ型LN可见不同程度的Survivin表达。如Ⅲ型、Ⅳ型的阳性率为100％，II型的阳性率为89．5％。I型与Ⅲ型、Ⅳ型、Ⅴ型的表达存在显著差异（P〈0．05）。I型与Ⅱ型、Ⅵ型LN的表达无显著差异（P〉0．05）。Survivin的表达与活动度呈正相关（r=0．352，P=O．001〈0．05），随组织活动度的增高，Survivin的表达也上升。Survivin的表达与蛋白尿、血尿无关。结论（1）各型LN中以增生型为主的LN中细胞凋亡更显著；（2）Survivin参与了LN的发生与发展过程；（3）在LN中，Survivin的表达与活动度呈正相关，因此Survivin阳性程度也可以作为LN病程发展的判断指标。

Apoptosis of renal cells and expression of apoptosis-associated protein survivin in lupus nephritis

Objective To investigate apoptosis of renal cells in lupus nephritis and if survivin participates in the development of lupus nephritis. Methods Apoptosis of renal cells were detected by TUNEL in 80 patients with different types of lupus nephritis; and expression of survivin was determinedby using immunohistochemical assay. Results The apoptotic rate was less than 1％ in type Ⅰ ( minimal change disease ) and type Ⅵ ( sclerotic lupus nephritis ) but greater than 20％ in types 1Ⅱ, Ⅲ, Ⅳ, and Ⅴ ( proliferative lupus nephritis ). The apoptotic index was correlated with proteinuria ( r = 0.312, P=0.005 ) but not associated with the degree of hematuria and disease activity. The expression rate of survivin was low in types Ⅰ and Ⅵ ( 14.3％ and 33.3％, respectively ) but it increased differently in type Ⅱ, Ⅲ,Ⅳ, and Ⅴ ( 100％ in types Ⅲ and Ⅳ and 89.5％ in type Ⅱ ). There was a significant difference between type Ⅰ and type Ⅲ, Ⅳ, or Ⅴ ( P＜ 0.05 ), but no significant difference between type Ⅰ and type Ⅱ or Ⅵ ( P＞ 0.05 ). Survivin expression was positively related with disease activity ( r = 0.352, P= 0.001 ).The expression of survivin increased with an increasing activity case. Survivin expression was not associated with proteinuria or hematuria. Conclusions Apoptosis is more significant in proliferative lupus nephritis.Survivin participates in the genesis and development of lupus nephritis. The expression rate of survivin can be used as an indicator for judging the development of lupus nephritis because of the association of survivin expression with activity.