肾综合征出血热发病中不溶性免疫复合物的作用  

Effect of the insoluble immunocomplexes on pathogenesis of hemorrhagic fever with renal syndrome

作　　者：黄晓峰[1] 刘彦仿[1] 尹文[1] 王爽[2] 亢君君[1] 李永强[1] 

机构地区：[1]第四军医大学基础部中心实验室,陕西西安710032 [2]第四军医大学基础部病理学与病理生理学教研室,陕西西安710032

出　　处：《电子显微学报》2009年第6期548-555,共8页Journal of Chinese Electron Microscopy Society

摘　　要：目的:为确定肾综合征出血热(HFRS)不溶性免疫复合物(IC)在发病中的作用。方法:本研究采用HFRS病毒抗原和相应抗体在体外制备成特异性的不溶性IC,经尾静脉注射入小鼠体内,而后应用免疫荧光组织化学方法结合激光扫描共聚焦显微镜和电子显微镜观察了病毒抗原及IC在各主要脏器的分布及其致病变作用。结果:IC注射后24h,主要见于血管系统如肝血窦和肾小球毛细血管之中。IC注射72h后,IC主要存在于肾小球基底膜部位以及血管系膜中,呈细小或粗大的颗粒状。肾小球毛细血管中红细胞明确阳性。某些血管腔中仍充满荧光物质,有些荧光物质位于足细胞的胞质内。在肾小球周围的部分肾小管上皮细胞可有IC,包括抗原和C3。不溶性IC注射后168h(7d),大多数肾小球结构接近正常,几乎看不到特异性的荧光。电镜观察发现病变以肾小球为主,发现系膜细胞伸出明显的胞质突起,并延伸至内皮和基膜之间。系膜细胞也有增生,可见沿细胞膜分布的中等数量的吞饮小泡以及胞浆中小的溶酶体颗粒。免疫沉积物可出现在肾小球系膜基质区,为不规则形,常聚集成团块状,呈散在分布,有时可见于内皮下、上皮下和/或基膜内。肾小球基膜呈不规则延伸、增厚,呈花斑状,并形成裂隙。IC注射后24h,某些毛细血管袢管腔中有血小板聚集。注射后72h,血小板聚集已不明显。某些毛细血管内皮细胞损伤严重,内皮细胞肿胀,部分区域内皮细胞突起脱落,基膜裸露。内皮细胞伸出许多绒毛状突起,互相交织融合形成拱状结构。胞浆中游离核糖体和粗面内质网增多。有些内皮细胞的胞质形成泡状结构。毛细血管管腔中充满一些电子致密的沉积物,并且这些电子致密物可通过内皮缺损与肾小球毛细血管基膜物质相连。肾小球囊壁层基膜外侧裸露,有胶原纤维形成。足细胞肿胀,突起融合,胞质中有�Objective：In order to determine the effect of the immunocomplexes on the pathogenesis of hemorrhagic fever with syndrome（HFRS）.Method：The insoluble antigen-antibody complexes was prepared in vitro,and was intravenously injected into BALB/c mice.The distribution of antigen,antibody and ICs was confirmed by fluorescence immunohistochemical method,combined laser scanning confocal microscopy and electron microscopy.Results：The results showed that IC was primarily distributed in blood vessels and sinusoids within 24 hours of the injection.From 72 hours after injection,the depositions of IC were found mainly on the basement membrane and in the spaces between mesangial cells in the kidney and on the wall of sinuses of the liver.The red blood cells within or without the blood vessels were IC positive.In the cytoplasm of podocytes and the tubular epithelia,IC fluorescence can be seen.Both the antigen,antibody and the C3 were found in the same places.Under electron microscope,the glomeruli showed the main changes.The masangial cells proliferated with its processes extended between the endothelial cells and the basement membrane.Deposits were found on the basement membranes,under the endothelia or under the epithelia.Irregular rarefied spaces could be seen in the deposits.Twenty-four hours after injection,blood platelets＇ aggregation within the glomerular capillaries could be discovered.After 72 hours,there were sloughing of endothelia with exposure of basement membrane.There was partial fusion of elongated villi to form arch structure.On the surfaces of red blood cells,there was evenly distributed electron dense particles.Conclusion：The results of this experiment showed clearly that：The insouble IC formed by antibody in excess,deposited principally on the basement membrane and was rarely seen in human cases.

关 键 词：肾综合征出血热 免疫复合物 免疫组织化学 激光扫描共聚焦显微镜技术 超微结构 

分 类 号：R512.8[医药卫生—内科学]