Glomerular chemokine expression and the effect of steroid and cyclophosphamide pulse therapy in human crescentic glomerulonephritis  

激素联合环磷酰胺冲击治疗对新月体肾炎肾小球趋化因子的影响(英文)

作　　者：陈书芬[1] 刘志红[1] 陈惠萍[1] 周虹[1] 王建平[1] 黎磊石[1] 

机构地区：[1]南京大学医学院金陵医院肾脏病研究所,南京210002

出　　处：《Chinese Medical Journal》2002年第9期1301-1307,共7页中华医学杂志（英文版）

摘　　要：OBJECTIVE: To study glomerular expression of C-C chemokines, monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1alpha and beta (MIP-1alpha, MIP-1beta) and the effect of steroid and cyclophosphamide (CTX) intermittent intravenous pulse therapy on expression in patients with crescentic glomerulonephritis (CGN) to further investigate the underlying mechanism of the treatment. METHODS: Twelve patients with initial biopsy-proven CGN(2), 6 with lupus nephritis (lupus-CGN, LN-CGN) and 6 with vasculitis, (vasculitis-CGN, V-CGN) were enrolled in this study. They underwent an initial biopsy before steroid and CTX intermittent intravenous pulse therapy and were biopsied again one to three months later. Expression of MCP-1, MIP-1alpha, MIP-1beta, and CD68 in glomeruli with cellular and fibrocellular crescents were examined by immunohistochemical analysis in serial sections of renal biopsies. The effect of the pulse therapy on histopathological changes was also observed. RESULTS: Although steroid and CTX intermittent intravenous pulse therapy markedly reduced the degree of glomerular crescent formation both in LN-CGN and V-CGN, the effect of the therapy on glomerular chemokine expression was significantly different between LN-CGN and V-CGN. It was found that steroid and CTX intermittent intravenous pulse therapy reduced the expression of CD68, MCP-1, and MIP-1alpha, but had no effect on MIP-1beta in glomeruli with cellular crescents of patients with LN-CGN. In patients with V-CGN, the therapy also reduced the expression of CD68, but had no effect on MCP-1, MIP-1alpha, and MIP-1beta in glomeruli with cellular crescents. It was noted that the degree of glomerulosclerosis and tubular interstitial fibrosis increased more significantly at the second biopsy in V-CGN as compared to LN-CGN. CONCLUSIONS: The efficacy of steroid and CTX intermittent intravenous pulse therapy in CGN might be affected by reduction of glomerular chemokine expression. The different changes in glomerular expression of MCP-1 and MIP目的　观察激素及环磷酰胺静脉冲击治疗对新月体肾炎 (CGN)患者肾小球单核细胞趋化蛋白 1(MCP 1)、巨噬细胞炎性蛋白 1α和β (MIP 1α、MIP 1β)以及CD6 8表达的影响 ,进一步阐明其治疗CGN的机制。方法　选择激素及环磷酰胺静脉冲击治疗 1至 3个月后进行重复肾活检的CGN患者 12例 ,其中狼疮性肾炎 (LN CGN)和血管炎 (V CGN)患者各 6例。应用免疫组织化学方法检测肾小球MCP 1、MIP 1α、MIP 1β和CD6 8的表达。结果　虽然激素及环磷酰胺静脉冲击治疗能够明显减少CGN患者肾小球新月体数 ,其对狼疮肾炎和血管炎肾小球中趋化因子表达的影响明显不同。LN CGN患者细胞性新月体的肾小球中CD6 8、MCP 1和MIP 1α的表达均较治疗前明显减少 ,有显著性差异 ,MIP 1β的表达也较治疗前有所下降 ,但无显著性差异 ;V CGN患者细胞性新月体的肾小球中CD6 8较治疗前明显下降 ,有显著性差异 ,而MCP 1、MIP 1α和MIP 1β较治疗前有所下降 ,但无显著性差异。重复肾活检时 ,V CGN肾小球硬化及小管间质纤维化程度明显高于LN CGN。结论　激素及环磷酰胺静脉冲击对LN CGN和V CGN的治疗反应不同 ,可能与肾小球MCP 1、MIP 1α和MIP

关 键 词：Adolescent Adrenal Cortex Hormones Adult Antigens  CD Antigens  Differentiation  Myelomonocytic Biopsy Chemokines  CC Child CYCLOPHOSPHAMIDE Female GLOMERULONEPHRITIS Humans Kidney Glomerulus Macrophage Inflammatory Protein-1 Male Middle Aged Monocyte Chemoattractant Protein-1 

分 类 号：R692.3[医药卫生—泌尿科学]