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目的观察单纯性血尿患儿肾组织免疫病理变化及肾小管CD40的表达,探讨免疫炎症反应在其发病机制中的作用。方法选取2004年1月-2007年3月在苏州大学附属儿童医院就诊并行肾活检的单纯性血尿患儿32例。全部患儿肾活检后,取部分肾组织经快速冷冻切片,进行常规病理和免疫荧光分析。同时采用免疫组织化学方法检测其肾小管CD40表达情况,采用计算机图像分析系统拍摄数字图像。采用Image-Pro Plus 5.02病理图文分析系统,计算各处理组肾小管CD40阳性表达率,并进行统计学分析。结果不同临床类型的单纯性血尿患儿肾组织病理主要表现为系膜增生性改变,其中轻度增生和弥漫性增生分别占全部患儿的37.50%和46.88%,伴局灶/阶段性细胞增生、坏死、纤维化和肾小球硬化者5例(占15.63%),未见膜性肾病和弥漫性硬化性肾小球肾炎病例。不同临床类型、病理类型的患儿均见IgA和(或)IgM沉积,其中系膜区以IgA沉积为主者占全部患儿的62.50%,且常伴IgM和(或)IgG沉积,单纯表现为IgA沉积者仅1例。以IgM沉积为主(不伴IgA)者占全部患儿的37.50%,其中仅有IgM者9例,占全部患儿的28.13%,伴IgG沉积者3例(占9.37%)。与对照组比较,各单纯性血尿组患儿肾小管CD40表达均显著增高(P<0.05)。不同病理类型之间:弥漫性系膜增生(Ⅲb级)患儿肾小管CD40表达率略高于轻微改变(Ⅰ级)患儿,二者比较差异无统计学意义(P>0.05)。伴Ⅱ级改变的患儿肾小管CD40阳性表达率较Ⅰ级和Ⅲb级患儿均显著增高(Pa<0.05);Ⅱa级单纯性血尿组肾小管CD40表达率高于Ⅱb组,但二者比较差异无统计学意义(P>0.05)。结论不同临床类型的单纯性血尿患儿肾组织病理主要表现为系膜增生性改变,伴IgA和(或)IgM沉积,部分患儿可伴IgG等沉积。不同病理类型的单纯性血尿患儿肾小管CD40表达率均高于对照组,提示免疫炎症反应在单纯性血尿发病机制中起重要作用。
Objective To observe the immunopathological changes of renal tissue and the expression of CD40 in renal tissue in children with simple hematuria and to explore the role of immune inflammation in its pathogenesis. Methods Thirty-two children with simple hematuria who underwent renal biopsy from January 2004 to March 2007 at Children’s Hospital Affiliated to Soochow University were enrolled. All children with renal biopsy, take part of the kidney tissue by rapid frozen section, routine pathology and immunofluorescence analysis. At the same time, the expression of CD40 in renal tubules was detected by immunohistochemical method, and the digital image was taken by computer image analysis system. The Image-Pro Plus 5.02 pathological image analysis system was used to calculate the expression rate of CD40 in renal tubules in each treatment group, and statistical analysis was made. Results Kidney histopathology in children with simple hematuria of different clinical types mainly showed mesangial proliferative changes, of which mild hyperplasia and diffuse hyperplasia accounted for 37.50% and 46.88% of all children respectively, with focal / stage hyperplasia , Necrosis, fibrosis and glomerular sclerosis in 5 cases (15.63%), no membranous nephropathy and diffuse sclerosing glomerulonephritis cases. IgA and / or IgM deposits were found in children with different clinical types and pathological types, of which 62.50% were mainly IgA deposits in the mesangial area and were often accompanied by IgM and / or IgG deposition. Only 1 patient was IgA. The majority of patients with IgM (without IgA) accounted for 37.50% of all children, including only 9 cases of IgM, accounting for 28.13% of all children with IgG deposition in 3 cases (9.37%). Compared with the control group, the expression of CD40 in renal tubules of all simple hematuria groups were significantly increased (P <0.05). Among the different pathological types, the expression of CD40 in renal tubules of diffuse mesangial hyperplasia (Ⅲb grade) was slightly higher than that of mild change (grade Ⅰ). There was no significant difference between the two groups (P> 0.05). The positive rate of CD40 expression in renal tubules of grade IIa patients was significantly higher than that of grade I and IIIb children (Pa <0.05). The expression of CD40 in renal tubules of grade IIa hematuria was higher than that of group IIb The difference was not statistically significant (P> 0.05). Conclusion Kidney histopathology in children with simple hematuria of different clinical types mainly shows mesangial proliferative changes with IgA and / or IgM deposition and some children with IgG deposition. The expression of CD40 in renal tubules of children with simple hematuria of different pathological types were higher than that of the control group, suggesting that immune and inflammatory reactions play an important role in the pathogenesis of simple hematuria.