肾组织石蜡切片单克隆轻链荧光染色的临床应用  

Immunofluorescent staining for monoclonal immunoglobulin light chain on paraffin sections of kidney biopsies

作　　者：经艳 王荔枝 刘文君 杨帆 徐效如 梁丹丹 张明超 JING Yan;WANG Lizhi;LIU Wenjun;YANG Fan;XU Xiaoru;LIANG Dandan;ZHANG Mingchao(National Clinical Research Center for Kidney Diseases,Jinling Hospital,Nanjing 210016,China)

机构地区：[1]东部战区总医院国家肾脏疾病临床医学研究中心,南京210016

出　　处：《肾脏病与透析肾移植杂志》2025年第1期45-50,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：基础研究计划自然科学基金——基础研究计划重点项目(BK20243061)。

摘　　要：目的:探索单克隆轻链抗体行肾组织石蜡切片染色的临床意义。方法:分析2022年1月至2023年12月在国家肾脏疾病临床医学研究中心住院行自体肾活检的临床病理资料,在8376例肾活检患者中筛选了757例同时行冰冻切片和石蜡切片轻链染色的患者资料,对两种免疫染色的结果进行分析比较。结果:757例患者中284例无冰冻组织或冰冻组织无肾小球,450例冰冻组织和石蜡组织轻链染色结果基本一致,23例冰冻切片单克隆轻链抗体荧光染色结果不能明确沉积物是否为单克隆,而石蜡切片单克隆轻链抗体荧光染色能更好地区分两种轻链的染色强度,得以明确肾脏疾病诊断,包括增生性肾小球肾炎伴单克隆免疫球蛋白沉积10例,系统性轻链型淀粉样变性8例,骨髓瘤管型肾病3例,轻链近端肾小管病2例。结论:本文首次全面分析了轻链染色的质量和应对策略,发现单克隆轻链抗体石蜡切片荧光染色作为冰冻切片荧光染色的补充,具有重要诊断价值,尤其是对于单克隆免疫球蛋白相关肾病。Objective:To explore the clinical significance of monoclonal light chain antibody staining in renal tissue paraffin sections.Methodology:The clinical and pathological data of autologous renal biopsy performed in the National Clinical Research Center for Kidney Disease from January 2022 to December 2023 were analyzed.Among 8376 patients,757 patients underwent both frozen section and paraffin section light chain staining,and the results of the two kinds of immunostaining were analyzed and compared.Results:Among 757 patients,284 had no frozen tissue or no glomeruli in the frozen tissue.The light chain staining results of 450 cases were basically consistent between frozen and paraffin tissues.In 23 cases,the fluorescence staining results of monoclonal light chain antibodies on frozen sections could not clearly determine whether the deposits were monoclonal,whereas the fluorescence staining of monoclonal light chain antibodies on paraffin sections could better distinguish the staining intensity of the two light chains,thereby clarifying the diagnosis of kidney diseases.These included 10 cases of proliferative glomerulonephritis with monoclonal immunoglobulin deposits,8 cases of AL amyloidosis,3 cases of myeloma cast nephropathy,and 2 cases of light chain proximal tubulopathy.Conclusion:This paper provides the first comprehensive analysis of the quality and coping strategies for light chain staining,finding that monoclonal light chain antibody fluorescence staining on paraffin sections,as a supplement to fluorescence staining on frozen sections,has significant diagnostic value,especially for monoclonal immunoglobulin-related kidney diseases.

关 键 词：单克隆抗体 轻链 肾组织石蜡切片 免疫荧光法 

分 类 号：R692[医药卫生—泌尿科学]