肾小管间质损伤中补体激活的意义

ACTIVATION OF COMPLEMENT IN RENAL TUBULOINTERSTITIAL DAMAGE

采用单克隆抗体免疫荧光技术观察８４例肾活检标本中各种补体成分的定位情况。结果发现，正常肾组织中可有Ｃ５、Ｃ６、Ｃ７～９及终末补体复合物（ＴＣＣ）的少量沉积；不伴明显肾小管间质损害者中，早期补体沉积阴性，ＴＣＣ散在、微弱沉积；伴明显小管间质损害时常可见包括早期补体（Ｃ１、Ｃ３、Ｃ４）、中间补体（Ｃ５、Ｃ６）及终末补体（Ｃ７、Ｃ８、Ｃ９、ＴＣＣ）在内的所有补体的持续沉积，补体激活与免疫球蛋白沉积关系密切。早期补体的激活多发生在狼疮性肾炎、膜增殖性肾炎及ＩｇＡ肾病等引起的肾小管间质疾病中。ＴＣＣ的沉积与肾组织损伤之间关系密切。因此，可以考虑在肾小管间质损伤时，补体是作为基本致病因子参与作用的。

In 1994, 84 Kidney biopsy tissues were studied. Deposition of immunoglobulins (IgG, IgA, IgM) and various complement proteins (C1q, C3, C4, C5, C6, C7, C8, C9 and terminal complement complex neoantigens) in tubular cells, tubular basement membrane and tubulointerstitial blood vessels were studied in serial sections by immunofluorescence microscopy in order to study the significance and effect of complement activation on tubulointerstitial damage. The results showed: the normal kidney tissue appeared scattered C5, C6, C7～9, TCC neo antigen deposition. In patients without tubulointerstitial lesion, there was no early complement protein deposition and weak positive deposition of terminal complement complex neo antigen. In patients with significant tubulointerstitial lesion, it showed persisting deposition of all complements, including early complements, media complements and terminal complements. Complements deposition was also companied with one or more kinds of immunoglobulin deposition at the same time. The complements and immunoglobulins often deposit at the same segment of tubular basement menbrane. The finding suggested that there was close relationship between complements and immunoglobulins in tubulointerstitial damage. In lupus nephritis, mesangial proliferative glomerulonephritis and IgA nephropathy, early complement activiation often appeared. Also, there was a relationship between TCC deposition and the degree of renal tubular cells damage. Therefore, it can be concluded that complements may be an important pathogenetic factor in tubulointerstitial damage.