狼疮性肾炎患者肾小管周毛细血管C4d沉积及其意义  

Significance of peritubular capillary C4d deposition in patients with lupus nephritis

作　　者：李世军 刘志红[2] 周虹[2] 曾彩虹[2] 黎磊石[2] 

机构地区：[1]南京大学医学院临床学院 [2]南京军区南京总医院解放军肾脏病研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2005年第4期301-305,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:探讨狼疮性肾炎(LN)是否存在肾小管管周毛细血管(PTC)C4d沉积以及其沉积的病理生理机制。方法:455例经肾活检证实的LN患者,用间接免疫荧光法检测肾活检冰冻切片组织C4d、C1q和C3的沉积,并与21例C4d阳性的移植肾急性排斥患者进行比较。结果:15例LN患者(3·29%)肾小管PTCC4d弥漫阳性主要为Ⅳ型狼疮,其中,Ⅱ型LN3例,Ⅳ型LN9例,Ⅲ+Ⅳ型LN1例,Ⅳ+Ⅴ型LN2例。本组患者抗核抗体均强阳性,73·3%的患者抗dsDNA阳性,40%的患者抗Smith抗体阳性,60%的患者抗心磷脂抗体阳性,所有患者补体C3均明显下降,80%患者补体C4下降。同时,LNPTCC4d沉积阳性的患者,绝大多数合并其他补体成分的沉积,12例(80%)患者伴有C1q共沉积,4例患者(26·7%)伴C3沉积,2例患者(13·3%)伴IgG沉积,而21例移植肾C4d阳性急性排斥患者未发现其他补体成分的共沉积。LN患者PTCC4d阳性沉积者肾组织PTC无中性粒细胞浸润。结论:部分LN患者肾组织PTCC4d沉积,其存在自身免疫功能亢进和补体经典途径的激活。与移植肾急性排斥反应伴PTCC4d阳性的沉积者不同,LN患者PTCC4d阳性的同时,合并有其他补体成分的沉积,而其PTC并无特殊的病理学改变,提示LN患者PTCC4d沉积的机制有别于抗体介导的肾移植急性排斥,它的存在可能代表了LN中一个相对独特的亚型。Objective： Complement activation, by the classical and/or the alternative pathways, is involved in the pathogensis of inflammatory damages in lupus nephritis（LN）. Perutublar capillary C4d depositon, examined by immunofluoresence study, has been reported as an important marker for antibody-mediated allograft rejection in kidney transplantation. Decreament of serum levels of C4d has been reported associated with lupus activation. In this study, we investigated whether peritubular capillary C4d deposition is present in lupus patients and what do peritubular capillary C4d deposition represent in the context of pathogenesis and clinic-pathology association. Methodology： Four hundred and fivety five lupus patients were retrospectively recruited after an in-hopitalization evaluation and a percutaneous renal biopsy. Twenty one renal allograft recipients were included as the positive control, who were evaluated for acute allograft rejection and proven positive for peritubular capillary C4d deposition. Indirect immunofluorescence stainings using monoclonal anti-C4d, anti C1q, and anti-C3 antibodywere performd on cryostatic sentions of renal biopsy sample. Results： The peritubulary capillary deposition of C4d was found in only 15 lupus patients （3.29% of the total group） , with 3 classified as the WHO Class Ⅱ, 9 as the WHO Class Ⅳ, 1 as the WHO Class Ⅲ ＋ Ⅳ, and 2 as the WHO Class Ⅳ ＋ Ⅴ. Pathologically, the co-depostion pattern with Clq and C3 was quite different between lupus patients and allograft recipients with positive peritubulary capillary C4d deposition. And no polymorphoneclear leukocyte was found in the perutubular capillary area in patients with LN. The most frequent pattern in lupus patients was C4d with C1q codeposition （80%）, followed by codeposition of C4d with C3 （26.7%）, and C4d with lgG（13.3%） were less common in these patients. While, Clq and C3 deposition were not detected in all the control eases of acute allograft rejection. Clinically, a higher proportion of po

关 键 词：C4D 狼疮性肾炎 管周毛细血管 毛细血管 肾小管 患者 沉积 移植肾急性排斥反应 抗心磷脂抗体阳性 其意义 

分 类 号：R593.242[医药卫生—内科学] R699.2[医药卫生—临床医学]