人类IgA肾病间质小管中炎性细胞的研究

目的探讨人类IgA肾病(IgAN)间质小管中炎性细胞(CD4+、CD8+、CD25+、MAC387+、27E10+)与临床肾功能以及病理的关系。方法对36例IgAN患者肾组织石蜡切片行PAS染色及免疫组化染色(CD4、CD8、CD25、MAC387、27E10),利用电子图像分析系统测量间质小管面积(mm2),计算单位面积间质小管中炎性细胞数目。结合病理指数(肾小球硬化,肾小管萎缩,间质纤维化程度)及肾活检前后肾功能,用SPSS软件包进行统计学分析。结果在肾间质小管中,CD4+、CD8+细胞均与间质纤维化呈正相关(r=0.38、0.37,P均<0.05):CD8+细胞与肾小球硬化相关(r=0.40,P<0.05)。间质CD4+、CD8+以及MAC387+细胞数均与肾活检前Scr呈正相关(r=0.37、0.39、0.36,P均<0.05)。多元逐步回归分析显示,CD8+以及MAC387+细胞数是预测肾功能的主要相关因素。4例ESRD患者27E10+细胞数明显多于非ESRD患者组。结论浸润于间质小管中的CD4+、CD8+、MAC387+在IgAN的肾功能和肾组织损伤中可能发挥重要作用。CD8+、MAC387+细胞数是影响IgAN预后的独立因素。间质27E10+细胞可能是预测IgAN进展的有效因子。

The role of tubulointerstitial inflammatory cells in human IgA nephropathy

Objective To investigate the relationship among interstitial infiltrating inflammatory cells (including CD4+, CD8+, CD25+, MAC387+ and 27E10+), renal function and pathological changes in IgA nephropathy (IgAN). Methods This study included 36 IgAN patients. PAS and immunohistochemistry method were applied to stain paraffin sections. The surface of interstitial tubules, the amount of CD4+, CD8+, CD25+, MAC387+, 27E10 + cells per unit were counted(cells/mm2), together with pathological changes (including glomerulosclerosis, tubular atrophy and interstitial sclerosis) and renal function during and after biopsy were determined by using image analysis system and SPSS software pack. Results In the renal tubulointerstitium, the number of CD4+ cells correlated with interstitial fibrosis (r=0.38 ,P<0.05) , the number of CD8+ cells correlated with the degree of interstitial fibrosis (r=0.37 ,P<0.05 ) and glomerular fibrosis (r=0.40,P<0.05). Clinicopathological study showed a relationship between the number of interstitial CD4+, CD8+, MAC387+ cells and the level of serum creatinine at the time of biopsy, with r=0.37, 0.39, 0.36 (all P< 0.05) respectively. The number of interstitial 27E10+ cells in end-stage renal disease (ESRD) patients was significantly higher than that of non-ESRD group. Conclusions Interstitial CD4+,CD8+ and MAC387+ cells may play important roles in functional and pathological damages in IgAN. The number of CD8 + and MAC387+cells is an independent prognosis factor in IgAN. Interstitial 27E10+ cells could be a powerful predictive factor in the progress of IgA nephropathy.