常用的免疫病理方法在轻链型肾淀粉样变性分型中的作用  

A Comparison of Immunopathological Methods in the Classification of Light Chain Renal Amyloidosis

作　　者：张帆 喻小娟[1,2] 王素霞[1,2] 屈磊[1,2] 马依依[1,2] 刘刚 杨莉[1,2] ZHANG Fan;YU Xiaojuan;WANG Suxia;QU Lei;MA Yiyi;LIU Gang;YANG Li(Renal Division,Renal Pathology Center,Department of Medicine,Peking University First Hospital;Institute of Nephrology,Peking University,Beijing 100034,China)

机构地区：[1]北京大学第一医院肾脏内科,肾脏病理室 [2]北京大学肾脏病研究所,北京100034

出　　处：《标记免疫分析与临床》2020年第5期818-822,共5页Labeled Immunoassays and Clinical Medicine

基　　金：国家自然科学基金面上项目(编号:81470956)。

摘　　要：目的探讨常用的免疫病理方法在轻链型肾淀粉样变性分型中的作用。方法选择北京大学第一医院肾内科经肾活检病理包括刚果红染色及电镜检查确诊的34例肾淀粉样变性患者为研究对象,根据冰冻组织保存的质量分为保存良好组(26例)和保存不佳组(8例),所有肾活检标本分别进行冰冻切片免疫荧光(F-IF)、石蜡切片免疫荧光(P-IF)及石蜡切片免疫组织化学(IHC)的轻链标记染色,比较3种方法在轻链型淀粉样变性分型中的灵敏度和特异性。结果26例冰冻组织保存良好组中,均可经冰冻切片免疫荧光染色确诊为轻链型淀粉样变性,非特异组织背景染色低,κ和λ轻链荧光强度差距大,灵敏度和特异性高,结果可靠。对此26例患者的石蜡切片进一步行免疫组化和免疫荧光检查发现,65.4%患者可以通过免疫组化正确分型,但κ和λ轻链组化染色强度差距减小、非特异的组织背景染色深;只有53.8%患者可以通过石蜡荧光正确分型,κ和λ轻链荧光染色强度差距小。进一步对8例冰冻组织保存欠佳的患者进行石蜡荧光、免疫组化染色分型,100%患者通过免疫组化确定为轻链型淀粉样变性,75%患者通过石蜡荧光确诊为轻链型淀粉样变性。结论轻链型淀粉样变性肾病的分型诊断中,首选灵敏度和特异性最好的冰冻免疫荧光染色方法;无冰冻组织或者冰冻组织保存不佳患者,可选择免疫组化或石蜡切片免疫荧光方法作为补救的分型方法。Objective To explore the role of immunopathology in the classification of light chain renal amyloidosis.Methods We retrospectively analyzed the clinical data of 34 patients who were pathologically diagnosed as renal amyloidosis.According to the quality of kidney frozen tissue preservation,these patients were divided into two groups:the well preserved group(n=26)and poorly preserved group(n=8).All renal biopsy specimens were stained with frozen immunofluorescence(F-IF),paraffin-fixed immunofluorescence(P-IF)and immunohistochemical(IHC),respectively.The sensitivity and specificity of staining among these three methods were then compared.Results In all the 26 cases with well preserved frozen tissues,light chain amyloidosis was able to be defined by light chain immunofluorescence staining on frozen sections with low background staining of nonspecific tissue,with significant difference in the fluorescence intensity betweenκandλlight chains,indicating reliable results with high sensitivity and specificity.Meanwhile,by using parafin embeded slides,immunohistochemistry staining could identify 17 cases(65.4%),while immunofluorescence examination only detected 14 cases(53.8%).Both methods had a reduced difference in the staining intensity betweenκandλlight chains,with markedly increased nonspecific tissue background.Among eight patients with poor cryopreservation,immunohistochemistry staining on paraffin slides was able to define light chain amyloidosis in all patients(100%),while P-IF examination diagnosed 6 cases(75%).Conclusion In diagnosing light amyloid nephropathy,F-IF remains the most optimal method with high sensitivity and specificity.For patients without frozen tissue or with poor cryopreservation of frozen tissue,immunohistochemical or paraffin-fixed immunofluorescence methods can be selected as the remedial typing methods.

关 键 词：肾淀粉样变性病 免疫球蛋白轻链 免疫荧光 组织化学染色 肾活检 

分 类 号：R692.9[医药卫生—泌尿科学]