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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。
Objective To investigate the relationship between inflammatory cells (CD4 +, CD8 +, CD25 +, MAC387 +, 27E10 +) and clinical renal function and pathology in human IgA nephropathy (IgAN) interstitial tubules. Methods PAS staining and immunohistochemical staining (immunohistochemical staining) of 36 paraffin sections of renal tissue from patients with IgAN were performed. The stromal tubule area (mm2) was measured by electron image analysis system, Inflammatory cells in the number. Combined with pathological index (glomerular sclerosis, tubular atrophy, interstitial fibrosis) and renal function before and after renal biopsy, using SPSS software package for statistical analysis. Results In the renal interstitial tubules, CD4 + and CD8 + cells were positively correlated with interstitial fibrosis (r = 0.38,0.37, P <0.05). CD8 + cells were associated with glomerulosclerosis (r = 0.40, . The number of stromal CD4 +, CD8 + and MAC387 + cells were positively correlated with Scr before renal biopsy (r = 0.37,0.39,0.36, P <0.05). Multivariate stepwise regression analysis showed that the number of CD8 + and MAC387 + cells was the main factor in predicting renal function. The number of 27E10 + cells in 4 ESRD patients was significantly higher than that in non-ESRD patients. Conclusion CD4 +, CD8 + and MAC387 + infiltrating the interstitial tubules may play an important role in the renal function and renal injury of IgAN. The number of CD8 +, MAC387 + cells is an independent factor affecting the prognosis of IgAN. Interstitial 27E10 + cells may be potent predictors of IgAN progression.