IgA肾病患者肾组织肥大细胞的分布及意义  

Mast cell infiltration in the renal tissue in patients with IgA nephropathy

作　　者：郑敬民[1] 尹广[1] 王建平[1] 李丽娟[1] 刘志红[1] 

机构地区：[1]南京军区南京总医院全军肾脏病研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2011年第2期114-119,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:了解不同亚型IgA肾病(IgA nephropathy,IgAN)患者肾组织中肥大细胞的分布及其与各种疾病指标的相关性,全面探讨肥大细胞在IgAN中的可能病理意义。方法:选取包括大量蛋白尿型、反复发作肉眼血尿型、高血压型、无症状尿检异常型、血管炎型在内的IgAN患者共110例,根据肾组织肥大细胞特异性高表达C3aR的特点,利用免疫组化的方法对所有患者的肾穿刺活检标本切片进行C3aR免疫组化染色,计数各切片C3aR强阳性细胞数,同时测量切片面积,计算各患者肾组织肥大细胞分布密度(同时选取正常供肾15例作为对照);在此基础上,利用统计学方法,进行肾组织肥大细胞密度与包括血、尿生化指标,肾小管间质相对面积和肾组织炎症细胞密度在内的各种病理指标进行相关性分析,探讨肥大细胞在IgAN中的病理意义。结果:(1)肥大细胞广泛存在于各亚型IgAN患者肾组织中;与正常对照相比,各亚型IgAN患者肾组织中的肥大细胞数均有明显的增加。(2)总的来看,肾组织中肥大细胞数与血肌酐和血CystatinC水平、尿视黄醇结合蛋白(RBP)和尿溶菌酶水平及间质炎症细胞数量,肾小管间质相对面积具显著相关性,而与尿C3、尿α2巨球蛋白(α2-MG)和24h尿蛋白水平及尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)水平则无明显相关性。(3)不同亚型IgAN肾组织肥大细胞与各种病理指标的相关性有明显差异,其中,反复发作肉眼血尿型与其他亚型的差异性最明显。结论:肥大细胞很可能参与了包括大量蛋白尿型、反复发作肉眼血尿型、无症状尿检异常型、高血压型和血管炎型在内的各种亚型IgAN的病理过程。肥大细胞在不同亚型IgAN中的地位和作用机制也可能存在差异。Objective： To realize the distribution of renal mast cells in patients with different subtype of IgA nephropathy （IgAN） and to investigate the possible roles of mast cells in the disease. Methodology：One hundred and ten cases including different subtypes of IgAN [ Massive proteinuria type （ MP, n = 18 ） , Recurrent gross hematuria type （ R-GH, n = 21 ） , Hypertension type （ HT, n = 18） , Asymptomatie urinary abnormality type （ U-ab, n = 18 ） , Vasculitic type （Vas, n = 36 ）] were selected and their renal sections of biopsies were analyzed by histological and immunohistochemical methods. The number of C3aR highly positive cells that represent renal mast cells in each section was counted, the density of the cell was calculated, and the correlation between mast cells and both clinical and pathological indexes were analyzed. Results ： Mast cells were found increased in the renal tissue of all IgAN subtypes when compared with that of transplantation donors. Ingeneral, the density of renal mast cells was found correlated significantly with indexes reflecting renal function （the levels of serum creatinine and cystatin C ） , indexes reflecting the degree of renal tubular injury （the levels of urine RBP and urine lysozymel ） and indexes reflecting the degree of interstitial injury （relative interstitial area and interstitial inflammation cells）. However, only in recurrent gross hematuria type, the number of renal inflammatory cells was correlated well with mast cells. In all IgAN subtypes, mast cells were found more often correlated well with indexes reflecting renal function and indexes reflecting interstitial injury. Conclusion：Renal mast cells may be involved and contribute to the development of all subtypes of IgAN. However, the exact mechanism and the manner the mast ceils exert their roles may vary in different subtype of the disease.

关 键 词：IGA肾病 C3aR 肥大细胞 

分 类 号：R692.3[医药卫生—泌尿科学]