CD44阳性肾小球壁层上皮细胞在早期预测局灶节段肾小球硬化中的价值  

The value of CD44-positive glomerular parietal epithelial cell in early prediction of focal segmental glomerulosclerosis

作　　者：杨晓青[1,2] 黄岩杰[1,2] 杨月丽 任献青[1] 丁樱[1] 翟文生[1] 张琳琪[3] YANG Xiao-qing;HUANG Yan-jie;YANG Yue-li;REN Xian-qing;DING Ying;ZHAI Wen-sheng;ZHANG Lin-qi(College of Pediatrics,Henan University of Chinese Medicine,Zhengzhou 450046,China;Laboratory of Renal Pathology,the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China;Department of Nephrology,the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学儿科医学院,郑州450046 [2]河南中医药大学第一附属医院肾脏病理实验室 [3]河南中医药大学第一附属医院肾脏内科,郑州450000

出　　处：《临床与实验病理学杂志》2022年第8期931-935,共5页Chinese Journal of Clinical and Experimental Pathology

基　　金：河南省中医管理局国家中医临床研究基地科研专项(2018JDZX064);河南省特色骨干学科中医学学科建设项目(STG-ZYXKY-2020027);河南省中医药学科领军人才项目[豫卫中医函(2021)8号]。

摘　　要：目的 探讨肾小球壁层上皮细胞(parietal epithelial cell,PEC)的活化和定位及在早期预测原发性局灶节段肾小球硬化(focal segmental glomerulosclerosis,FSGS)中的意义。方法 收集18例原发性FSGS和54例微小病变肾病(minimal change disease,MCD)患者的临床资料,采用免疫组化EnVision法检测肾小球CD44^(+)PEC在肾小球的表达位置和阳性率。根据组织学形态和临床随访信息,评价CD44^(+)PEC在肾小球基膜(glomerular basement membrane,GBM)上皮侧表达的诊断价值。结果 18例(100%)原发性FSGS均可见CD44^(+)PEC局灶节段定位于GBM上皮侧。54例MCD中有3例(5.56%)可见CD44^(+)PEC局灶节段定位于GBM上皮侧,提示存在可疑的FSGS病变;对3例患者行PAS染色,镜下仍未见明显的FSGS病变;临床表现均为非激素敏感型肾病综合征,可能是由于病程、病理取材的局限性等原因不能除外FSGS。结论 CD44^(+) PEC局灶节段定位于GBM上皮侧,有助于诊断和早期预测FSGS。Purpose To explore the significance of activation and localization of glomerular parietal epithelial cells(PEC) in early prediction of primary focal segmental glomerulosclerosis(FSGS).Methods The renal tissues of 18 cases of primary FSGS and 54 cases of minimal change disease(MCD) with clinical manifestations of nephrotic syndrome were collected.The expression location and rate of CD44^(+)-positive PEC in glomerulus were detected by immunohistochemistry method in continuous sections.Combination with histopathology and clinical follow-up information,the diagnostic value of CD44^(+)-positive PEC located in epithelial side of GBM was evaluated.Results CD44^(+)-positive PEC located in GBM epithelial side were found in 100% of the biopsies of patients diagnosed as primary FSGS.Among 54 cases of MCD,3 cases(5.56%) showed CD44^(+)-positive PEC locating in GBM epithelial side,which indicated suspicious FSGS lesions.In order to confirm the diagnosis,periodic acid-Schiff staining was performed on consecutive sections of the 3 patients,and no obvious FSGS lesions were found under the light microscope.However,the clinical manifestations of all 3 patients were non-steroid-sensitive nephrotic syndrome,suggesting that FSGS may not be excluded due to the disease duration and the limitation of pathological sampling.Conclusion CD44^(+)-positive PEC locating on the epithelial side of GBM is helpful for diagnosis and early prediction of FSGS.

关 键 词：微小病变肾病 局灶节段肾小球硬化 CD44 CLAUDIN-1 

分 类 号：R36[医药卫生—病理学]