不同增殖性肾炎细胞增殖与凋亡的关系

Proliferative gknerulonephritis: the profiles of proliferation and apoptosis

目的 观察细胞增殖与凋亡在膜增生性肾小球肾炎(MPGN)、弥漫增生性狼疮性肾炎(LN)和急性感染后肾炎(APGN)的表现。方法 用原位末端标记方法对12例MPGN,15例LN和13例APGN患者肾活检组织中肾小球内凋亡细胞进行了观察,并用免疫组化方法同时对增殖细胞(PCNA染色阳性细胞)进行了分析。结果 在肾小球细胞增殖的同时,MPGN和LN患者表现出明显的凋亡不足的征象,而APGN患者则伴活跃的细胞凋亡。凋亡细胞数在APGN明显大于MPGN和LN,而增殖细胞与凋亡细胞的比值则以MPGN最大。结论 不同的增生性肾炎由于病因和病变性质不同,虽然都表现出细胞增殖,但其凋亡机制的反应性存在着明显的差异,这可能是上述三种增生性肾炎预后不同的因素之一。

Objective Hypercellularity in proliferan've glomerulonephritis can result from either increased proliferation or the failure of cells to undergo apoptosis in response to stimuli. Increasing evidence supports that alterations in the control of cell survival are important in the pathogenesis of proliferative glomerulonephritis. Methods Apoptotic cells in the glomeruli have been analyzed by the in situ end labeling (ISEL) of TdT from patients diagnosed with membranoproliferative glomerulonephritis (MPGN, n = 12), type IV lupus nephritis (LN, n = 15) and acute postinfectious glomerulonephritis (APGN, n = 13) in the present study. In addition, the proliferating cell nuclear antigen (PCNA)-positive proliferating glomerular cells were observed by immunochemical 4 layer PAP method in these patients. Results The ratio of proliferating and apoptotic cells was the highest one in patients with MPGN (3.91) as compared to APGN (1.28) and LN(1 .02). The extends of increasing apoptotic cells in the glomeruli were different among patients with MPGN,, APGN and LN, although all of them showed extremely glomerular hypercellularity. The number of apoptotic glomemlar cells was significantly higher in patients with APGN (1.16±0.35) than those with MPGN (0.12±0.16) as well as LN patients (0.35 ± 0.20). Conclusion Apoptosis is essential in the resolution of glomerular cellularity together with the remodeling processes. Intense proliferations without increment in apoptosis are the characterisitics of MPGN and LN associated with their renal histological changes and prognosis.