肾组织浸润细胞在新月体肾炎患者中的分布特点及意义(英文)

The distribution and significance of renal infiltrating cells in patients with diffuse crescentic glomerulonephritis

目的 研究肾组织各种浸润细胞在各类新月体肾炎发生发展中的发病机制。方法 分析 5 6例各类新月体肾炎患者肾组织中单核细胞 (CD6 8+ )及增殖细胞核抗原阳性细胞 (PCNA+ )的分布特点 ,并就它们与肾组织中淋巴细胞亚群CD4 + 及CD8+ 细胞浸润的关系进行分析探讨。结果 本组新月体患者肾组织中CD6 8+ 、PCNA+ 、CD4 + 及CD8+ 细胞均明显高于正常供肾组织。在Ⅰ型新月体肾炎患者肾组织中CD6 8+ 及PCNA+ 细胞数高于Ⅱ及Ⅲ型新月体肾炎患者。肾间质CD4 + 与肾小球CD6 8+ 及PCNA+ 细胞数呈线性相关者主要表现在Ⅲ及Ⅰ型新月体肾炎患者。结论 本文资料进一步证实肾组织各类浸润细胞在新月体肾炎发生发展中的重要作用。肾间质CD4 + 与单核细胞及PCNA+ 细胞呈直线正相关可能为新月体肾炎患者活动与否的一种标志。在狼疮性新月体肾炎患者肾组织中CD4 + 及CD6 8+ 细胞浸润与血管炎及Ⅲ型新月体肾炎患者相似 ,提示这些患者在新月体的形成中主要由细胞免疫异常所参与。

Objective To study the significance and distribution of renal infiltrating cells, including monocytes (CD68+ cells), proliferative cell nuclear antigen positive cells (PCNA+ cells), CD4+ and CD8+ cells in diffuse crescent glomerulonephritis (DCGN). Methods Fifty-six patients with DCGN were studied, including 10 cases of anti-glomerular basement membrane (GBM)-type Ⅰ DCGN, 26 immune complex-type Ⅱ DCGN, and 20 cases of pauci-immune-type Ⅲ DCGN. Glomerular and interstitial infiltrates of CD68+ and PCNA+ cells, and interstitial infiltrates of CD4+ and CD8+ cells were detected by using four-layer PAP methods. Results There was a significant increase of renal infiltrating CD68+, PCNA+, CD4+ and CD8+ cells in patients with DCGN compared with that in normal controls. In patients with type Ⅰ DCGN, there was a higher number of renal infiltrating CD68+ and PCNA+ cells than that in patients with type Ⅱ and Ⅲ DCGN. A glomerular infiltrates of CD68+ and PCNA+ cells correlated with the interstitial infiltrates of CD4+ cells in type Ⅰ or Ⅲ DCGN patients. In lupus DCGN patients, the numbers of renal infiltrating CD68+ and PCNA+ cells were similar to vasculitis or type Ⅲ DCGN patients.Conclusion These findings demonstrate that the renal infiltrates of CD68+ and PCNA+ cells play an important role in patients with DCGN, that the infiltrates of CD4+ cells correlate with the infiltrates of CD68+ and PCNA+ cells may be an active marker of DCGN, and that cell-mediated immunity may contribute to crescent formation in lupus DCGN patients.