原发性IgA肾病患者肾内Foxp3^+调节性T细胞表达情况及其与血尿酸的关系

Intrarenal Foxp3^+ expressing Regulatory T Iymphocytes Expansion and its Correlation with Serum Uric Acid in Human Immunoglobulin A Nephropathy

目的:探讨原发性IgA肾病(primary immunoglobulin A nephropathy,IgAN)患者肾内Foxp3+调节性T细胞(foxp3-expressing regulatory T lymphocytes,Tregs)的表达情况及其与血尿酸的关系。方法:纳入初发原发性肾小球疾病患者74例,其中52例IgAN和22例特发性膜性肾病(idiopathic membranous nephropathy,MN)患者。按照肾组织是否表达Foxp3将IgAN患者分为Foxp3+和Foxp3-两个亚组。采用免疫组织化学染色方式检测肾内Foxp3表达情况,记录患者入院次日清晨检测所得血尿酸(serum uric acid,SUA)、尿微量白蛋白、尿β2-微球蛋白和尿肌酐,采用同位素99mTc-DTPA示踪定量法检测肾小球滤过率(glomerular filtration rate,GFR)。结果:较之MN组,IgAN组患者肾内Foxp3表达比例显著增高。IgAN亚组分析中,Foxp3+较Foxp3-者SUA水平和镜下血尿检出率增高,但尿微量白蛋白/肌酐比(albumin to creatinine ratio,ACR)降低。Logistic回归分析显示,SUA是IgAN肾内Foxp3+Tregs是否表达的独立预测因素。结论:原发性IgAN患者肾内Foxp3+Tregs表达增多并受SUA水平影响,Tregs可能参与保护高尿酸血症所致肾病进展。

Objective: To examine the expression pattern of intrarenal Foxp3-expressing regulatory T lymphocytes(Tregs)and its relationship with serum uric acid(SUA) in human Immunoglobulin A nephropathy(IgAN). Methods: Newly diagnosed patients with primary IgAN(52 cases) and idiopathic membranous nephropathy(MN,22 cases) were enrolled. IgAN individuals were further stratified into subgroups with and without intrarenal Foxp3 immunostaining. Foxp3 expression was investigated through immunochemistry assays. SUA,urinary analysis and glomerular filtration rate(GFR) were recorded. Results: IgAN group showed higher frequencies and stronger staining intensity for intrarenal Foxp3+Tregs than MN group. In IgAN individuals,the Foxp3+subgroup revealed higher SUA level,more frequent hematuria,but less urinary albumin to creatinine ratio(ACR) than the Foxp3-cases. Binary logistic regression suggested that SUA might be one of the independent determinants for intrarenal Foxp3+Tregs in IgAN. In conclusion,increased expression of Foxp3+Tregs,positively affected by SUA level,is present in the kidneys of patients with primary IgAN.Tregs may be protective in the HUA-associated progression of renal injury. Conclusion: