扁桃体灭活菌株对IgA肾病扁桃体CD4^+CD25^+细胞和J链产生的影响  

Effect of tonsillar inactivate strain on tonsillar CD4+CD25+ cells and J chain production in patients with IgA nephropathy

作　　者：黄红东[1] 彭佑铭[1] 刘虹[1] 杨新明[2] 刘伏友[1] 

机构地区：[1]中南大学湘雅二医院肾内科湖南省肾脏疾病与血液净化学重点实验室,长沙410011 [2]中南大学湘雅二医院耳鼻喉科,长沙410011

出　　处：《肾脏病与透析肾移植杂志》2007年第3期215-221,300,共8页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：中南大学研究生教育创新工程资助课题(2349)

摘　　要：目的:以扁桃体隐窝内甲型链球菌(HS)灭活菌株刺激IgA肾病(IgAN)患者和非肾炎患者扁桃体淋巴细胞,观察未刺激及刺激后CD4+CD25+细胞和分泌J链IgA细胞数量,探讨IgAN的发病机制。方法:(1)收集37例IgAN患者及37例非肾炎慢性扁桃体炎患者手术摘除的扁桃体;(2)分离鉴定两组患者扁桃体隐窝内细菌及分离培养扁桃体淋巴细胞;(3)以分离最多的灭活菌株HS体外刺激扁桃体淋巴细胞72h;(4)以流式细胞仪检测扁桃体淋巴细胞CD4+CD25+细胞数,以原位杂交技术检测J链mRNA表达,以免疫荧光及荧光原位杂交技术同步分析分泌J链IgA细胞。结果:(1)两组患者均有甲型链球菌,且甲型链球菌在分离的细菌中是最多的。两组患者的细菌谱和细菌量无统计学差异。(2)未刺激、非肾炎患者HS(HS-controls)、IgAN患者HS(HS-IgAN)刺激后CD4+CD25+细胞数[(0.98±0.204)% vs (3.58±0.554)%,P<0.05,(1.37±0.214)% vs (5.78±0.562)%,P<0.05,and(1.43±0.202)% vs (6.05±0.521)%,P<0.05],IgAN组与非肾炎组比较,前者均显著低于后者。HS对IgAN组CD4+CD25+细胞的刺激指数(stimulation index,SI)显著低于非肾炎组(P均<0.05)。(3)未刺激、HS-controls、HS-IgAN刺激后J链mRNA阳性IgA细胞[(11.9±3.1)% vs (6.5±1.5)%,P<0.05,(33.5±5.7)% vs (13.9±1.2)%,P<0.05,and(35.1±6.2)% vs (13.9±1.2)%,P<0.01],IgAN组与非肾炎组比较,前者均显著高于后者。HS对IgAN组J链mRNA阳性IgA细胞的SI显著高于非肾炎组(P均<0.01)。(4)HS对CD4+CD25+细胞的SI与对分泌J链IgA细胞的SI呈显著性负相关(P均<0.01)。结论:IgAN患者扁桃体CD4+CD25+细胞减少和分泌J链IgA细胞增多可能与IgAN的发病机制有关。Objective ：To observe CD4^＋ CD25^＋ ceils and J chain mRNA-positive IgA ceils in tonsiUar lymphocytes unstimulated or stimulated with heat-inactivated a-hemolytic streptococcus （HS） isolated from the tonsiUar crypts of patients, and to investigate the pathogenesis of IgA nephropathy （IgAN）. Methodology： Bacterial strains were isolated from the tonsiUar crypts of all patients. The a-hemolytic streptococcus was the most common among these bacterial strains isolated. The lymphocytes from tonsils of patients were cultured for 72 hours under the unstimulation or stimulation of HS isolated from the tonsillar crypts of all patients with IgAN or without renal disease. 37 patients with IgAN and 37 patients without renal disease were studied. The CD4^＋ CD25 ^＋ cells were examined by flow cytometry. The expression of J chain mRNA was examined by in situ hybridization and the J chain mRNA-positive IgA ceils were identified by combined immunofluorescence and fluorescent ISH. Results：The a-hemolytic streptococcus was found in the tonsillar crypts of each patient, it was the most common among these bacterial strains isolated. The bacterial strains were not accepted as statistically significant between the analyzed two groups. The CD4^＋ CD25^＋ cells significantly decreased in IgAN patients compared to the patients without renal disease unstimulation or stimulation with HS-controls（ HS isolated from the tonsillar crypts of patients without renal disease）or with HS-IgAN （HS isolated from the tonsillar crypts of patients with IgAN） [ （0.98±0. 204）% vs （3.58 ±0. 554）% ,P 〈0. 05, （ 1.37 ±0. 214）% vs 5.78±0. 562）%, P 〈0. 05, and （ 1.43 ±0. 202）% vs （6.05± 0. 521 ） %, P 〈 0.05 ]. The CD4^＋ CD25^＋ cells from patients with IgAN showed a significantly lower stimulation index （SI） to HS-controls or to HS-IgAN than those from patients without renal disease （ all P 〈 0. 05）. The J chain mRNA- positive IgA cells significantly increased in IgAN patients compared

关 键 词：IGA肾病 扁桃体 CD4^+CD25^+细胞 J链mRNA IgA细胞 

分 类 号：R692.3[医药卫生—泌尿科学]