弥漫增生型狼疮性肾炎肾组织中细胞凋亡的研究

A Study of Apoptosis in Renal Tissue of Diffuse Proliferative Lupus Nephritis

目的 探讨狼疮性肾炎 (LN)肾组织中细胞凋亡程度及其与病理组织学及临床参数改变间的关系。方法 对 2 5例Ⅳ型LN与 12例IgA肾炎 (IgAN)、4例系膜增生性肾炎 (MsPGN)、3例急性链球菌感染后肾炎(APSGN)的肾活检组织采用原位末端标记法检测凋亡细胞 ,免疫组化ABC法 (PCNA)检测增殖细胞。结果 狼疮性肾炎较其他类型增殖性肾小球肾炎肾组织中凋亡细胞数低 ,而PCNA阳性细胞数 /TdT阳性细胞数的比值(P/T值 )最高 ;肾小球及小管间质的P/T值均与肾组织病变慢性化指数相关 ,为r =0 .4983(P =0 .0 13 2 ) ,r =0 .8399(P <0 .0 0 1) ,r =0 .6 6 14(P =0 .0 0 3 3) ;肾小球及肾小管的P/T值与 2 4h尿蛋白定量成正相关 ,为r =0 .85 5 4(P <0 .0 0 1) ,r =0 .713 4(P =0 .0 0 1) ;与Ccr成负相关 ,为r =- 0 .4880 (P =0 .0 13 3) ,r =- 0 .72 2 9(P =0 .0 0 1) ;肾小管的P/T值与Scr成正相关 ,r =0 .410 7(P =0 .0 414)。结论 增殖性狼疮性肾炎存在细胞凋亡不足 ,显著的细胞增殖而无相应的凋亡增强可能与狼疮性肾炎呈现慢性进展有关。

Purpose: To evaluate apoptosis in renal tissue of diffuse proliferative lupus nephritis and the relationship between the existence of apoptosis cells in renal tissue and histopathological or clinical changes. Methods: Apoptosis was detected by in situ nick-end labeling techniques (TUNEL) in renal biopsies from 25 patients with type IV LN, 12 patients with IgAN, 4 patients with MsPGN, and 3 patients with APSGN. Norman renal tissue obtained at nephrectomy for hypernephroma in 4 adults was used as control. In addition, proliferating cells were identified by proliferating cell nuclear antigen(PCNA) in these patients. Results: Compared to other proliferative glomerulonephritis and control, the patients with lupus nephritis had less apoptosis cells, higher ratio of PCNA+ cells/TdT+ cells/(P/T) in renal tissues; Ratio of P/T in glomeruli and tubulointerstitium correlated with the chronicity index, r = 0.498 3 (P = 0.013 2), r = 0.839 9 (P < 0.001), r = 0.661 4 (P = 0.003 3), respectively. Ratio of P/T in glomerulus and tubule had positive correlation with 24 hour urinary protein, r = 0.855 4(P < 0.001), r = 0.713 4 (P = 0.001); negative correlation with Ccr, r = - 0.488 0(P = 0.013 3) and r = -0. 722 9 (P = 0.001), which in tubules positively correlated with Scr, r = 0.410 7 (P = 0.041 4). Conclusions: Apoptosis is insufficient in proliferative lupus nephritis. Intense proliferation without following increase in apoptosis may be related to chronic progressive renal histopathological changes.