摘要
目的:观察肥大细胞在抗肾小球基膜(GBM)肾炎患者肾脏浸润中的临床意义。方法:选取38例经肾活检确诊为抗GBM肾炎的患者,收集其临床病理资料。通过免疫组化染色检测肾组织中肥大细胞(类胰蛋白酶)。根据浸润肾肥大细胞计数将患者分为组1(肥大细胞<50个/mm2,n=18)和组2(肥大细胞≥50个/mm2,n=20)。比较两组患者临床症状、实验室检查和病理指标的差异,并对肥大细胞浸润和临床与病理指标之间的相关性进行分析。结果:与组1相比,组2患者病程较长、年龄较大、发生肉眼血尿者较多、少尿/无尿比例较高,蛋白尿、镜下血尿、低蛋白血症较轻,而贫血程度较重、抗GBM抗体滴度较高。同时,组2患者肾损伤程度较重,血清肌酐(SCr)(791±324μmol/L vs 412±241μmol/L,P<0.001),尿视黄醇结合蛋白(RBP)(29.8±13.9 mg/dl vs 15.7±11.5 mg/dl,P=0.005)水平较高,尿渗透压较低[285±82.37 mOsm/(kg·H2O)vs 429±359 mOsm/(kg·H2O),P=0.001]。组2患者肾小球硬化和包囊破裂的比例亦较高,间质纤维化程度较重,但两组之间无显著差异;纤维性/纤维细胞新月体比例较高(66.7%±21.9%vs 47.0%±33.6%,P=0.037),细胞性新月体比例较低,但无显著差异。组2患者肾组织间质还可见较多炎性细胞浸润(包括CD4+、CD8+及CD68+细胞)。其中CD8+细胞(180个/mm2vs 268个/mm2,P=0.045)及CD68+细胞(534个/mm2vs 792个/mm2,P=0.017)浸润在两组之间存在显著差异。此外,肥大细胞与新月体和肾小管间质炎症细胞(包括CD68+细胞和T淋巴细胞)的数量显著相关。结论:抗GBM肾炎患者肾脏肥大细胞浸润和慢性病变相关。
Objective：To investigated the roles of renal mast cell infiltrations in patients with anti-GBM nephritis.Methodology：Thirty eight patients diagnosed as anti-GBM nephritis in our institute from 2001 to 2010 were enrolled in this study.Renal biopsies were performed in all patients.The clinical and pathological data were collected.The tryptase was stained by immunohistochemistry for detecting mast cells in renal tissue.According to the infiltrating renal mast cell count,the patients were divided into group 1 （mast cell ＜ 50/mm2,n =18） and group 2 （mast cell ≥50/mm2,n =20）.The clinical,laboratory and pathological indices were compared between the two groups.Correlation between mast cells and patients＇ clinical and pathological indices was investigated.Results：In patients of group 2,they had longer disease course,older in age,higher percents of gross hematuria,oliguria/anuria,a more serious degree of anemia and less urine protein and microscope hematuria,as well as a higher level of anti-GBM antibodies.Moreover,the patients in group 2 were more serious in renal dysfunctions,which expressed as higher levels of serum creatinine [SCr,（791 ± 324） μmol/L vs （412 ±241） μmol/L,P ＜ 0.001] and urine retinol-binding protein [RBP,（29.8 ± 13.9） mg/dl vs （15.7 ± 11.5）mg/dl,P =0.005],but lower urinary osmotic pressure.In pathology,the patients in group2 were observed to have a higher percentage of glomerular sclerosis and Bowman＇s wall fracture and more serious degree of fibrosis although no significantdifferences were observed.They also had a higher percentage of fibrous/fibrocellular crescents [（66.7％ ± 21.9％） vs （47.0％ ± 33.6％）,P =0.037] while a lower cellular crescents in group 2.There were more inflammatory cells including CD4,CD8 and CD68 positive cells infiltrated in the interstitium of group 2.Among these inflammatory cells,the infiltration of CD8 positive T cell （268/mm2 vs 180/mm2,P =0.045） and CD68 positive T cell （792/mm2 vs 534/mm2,P =0.017）had a s
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2013年第4期324-329,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
抗肾小球基膜肾炎
肥大细胞
胰蛋白酶
纤维化
anti-glomerular basement membrane nephritis
mast cells
tryptase
fibrosis
