单纯性血尿患儿肾组织免疫病理及肾小管CD_(40)的表达

Analysis of Renal Immunopathology and Expressions of CD_(40) in Tubules in Children with Single Hematuria

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 investigate renal immunopathologic changes and expressions of CD40 in tubules of children with single hematuria, and to explore the role of immune inflammatory reaction in the pathogenesy of single hematuria. Methods Thirty - two cases of children suffered from single hematuria,hospistalized and performed renal biopsy in the Children＇s Hospital Affiliated to Soochow University were adopted from Jan. 2004 to Mar. 2007. After biopsy, half of renal tissues were harvested and made into frozen sections, and analysis were followed by routine pathology and immunofluorescence. Meanwhile ,the expressions of CD40 in tubules were detected by immunohistochemistry,digital photographs were captured by computer image analysis system. Positive expression rate of CD40 in tubules was calculated by pathological graphic analysis system - Image - Pro Plus 5.02,and statistical analysis was followed. Results Children suffered from different clinical types of single hematuria mainly presented mesenterium proliferative changes, of which the percentage of minor and diffuse proliferation were 37.50% and 46.88%, respectively, and 5 children represented focal/segmental cell proliferation, necrosis,fibrosis and glomerular sclerosis,which covered 15.63% of total cases. Deposition of IgA and （or） IgM were seen in different clinical and pathological types, of which deposition of mainly IgA in mesenterium area covered 62.50% in all cases, many of them with IgM and （or） IgG. Deposition of mainly ｜gM （ without IgA） was 37.50%,of which 9 cases had only IgM deposit,which was 28.13% of all cases;and 3 cases also had IgG deposit,the percentage was 9.37%. Contrasting with control group,the expressions of CD40 in tubules of the sufferers in each single hematuria group were increased significantly（ P 〈 0.05 ）. Between different pathological types：expressions of CD40 in tubules of children with diffused mesenterium proliferation（ grade Ⅲb） were slightly higher than those in children with minor changes（ grade Ⅰ）, and the difference had no significance （P 〉 0.05 ）. The positive expression rate of CD40 in tubules of children with changes of grade Ⅱ was increased significantly than those in grade Ⅰ and grade Ⅰb （Pa 〈 0.05 ）. The expressions of CD40 in tubules of children suffered from grade Ⅱa was higher than those with grade lib,but the difference had no significance （ P 〉 0.05 ）. Conclusions The renal tissue pathology of children with different clinical types of single hematuria mainly represented mesenterium proliferative changes ,with deposition of IgA and （or） IgM, part of which with deposition of IgG. The expressions rate of CD40 in tubules of children with different pathological typos of single hematuria are all higher than those in control group,suggesting that the immune inflammatory reaction plays an important role in the pathogenesy of single hematuria.