新月体肾炎患者肾组织中浸润细胞的分布特点及临床意义
作者：唐政 吴燕 胡伟新 姚小丹 周红 陈惠萍
单位：210002 南京军区南京总医院 南京大学医学院临床学院肾脏科
关键词：肾小球肾炎；免疫；病理；浸润细胞
中华肾病杂志000413摘 要：目的 研究肾组织各种浸润细胞在新月体肾炎的发病机制中的作用。方法 分析56例各类新月体肾炎患者肾组织中CD68+及PCNA+细胞在各类新月体肾炎患者肾组织中的分布特点，并就它们与肾组织中CD4 及CD8+细胞浸润的关系进行分析探讨。结果 本组新月体肾炎患者肾组织中 CD68+、PCNA+、CD4+及CD8+细胞均明显高于正常供肾组织。在Ⅰ型新月体肾炎患者肾组织中CD68+及PCNA+细胞数高于Ⅱ型及Ⅲ型新月体肾炎患者。肾间质CD4+与肾小球cD68+及PCNA+细胞数呈线性相关者主要表现在Ⅲ型及Ⅰ型新月体肾炎患者。结论 肾间质CD4+与单核细胞及PCNA+细胞呈直线正相关可能为新月体肾炎患者活动与否的一种标志。在狼疮性新月体肾炎患者肾组织中CD4+及CD68+细胞浸润与血管炎及Ⅲ型新月体肾炎患者相似，提示这些患者在新月体的形成中主要由细胞免疫异常所参与。
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The distribution and significance of renal infiltrating cells in patients with diffuse crescentic glomerulonephritis
TANG Zheng ,WU Yan ,HU Weixin
(Department of Nephrology,Jinling Hospital, School of Medicine, Nanjing University,Nanjing 210002,China)
Abstract：Objective To investigate the significance and distribution of renal infiltrating cells including monocytes (CD68+ cell),proliferative nuclear antigen positive cells (PCNA+ cell),CD4+ and CD8+ cells in diffuse crescentic glomerulonephritis (DCGN). Methods 56 patients with DCGN were studied,including 10 case of anti-glomerular basement membrane (GBM) -type I DCGN,26 complex immune-type Ⅱ DCGN,and 20 case of pauci-immune-type Ⅲ DCGN.The glomerular and interstitial infiltrates of CD68+ and PCNA+ cells, and the interstitial infiltrates of CD4+ and CD8+ cells were detected by four-layer PAP method.Results There was a significant increase of renal infiltrating CD68+,PCNA+,CD4+ and CD8+ cells in patients with DCGN compared with that in donors.In patients with type I DCGN,there was a higher of renal infiltrating CD68+ and PCNA+ cells than that in patients with type Ⅱ and Ⅲ DCGN.The glomerular infiltrates of CD68+ and PCNA+ cells correlated with the interstitial infiltrates of CD4+ cells in type Ⅰ or Ⅲ DCGN patients.In lupus DCGN,the numbers of renal infiltrating CD68+ cells PCNA+ cells were similar to vasculitis or type Ⅲ DCGN patients.Conclusions These findings demonstrate that (1) the renal infiltrates of CD68+ and PCNA+ cells play an important role in patients with DCGN.(2)the renal infiltrates of CD4+ cells correlated with the infiltrates of CD68+ and PCNA+ cells may be an active marker of DCGN.(3) the cell-mediated immune pathogenesis may contribute to crescentic formation in lupus DCGN patients.
, http://www.100md.com
Keywords：Glomerulonephritis;Immune;Pathology;Infiltrating cell
参考文献：
[1]胡伟新，黎磊石，陈惠萍，等.微型多动脉炎肾损害的早期诊断.中华肾脏病杂志,1995,11:28-31.
[2]Tang Z,Zhou H,Zhang SL,et al.Significance of anti-neutrophil cytoplasmic antibodies in patients with pauci-immune crescentic glomerulonephritis.Chin Med J,1999,112:1143-1146.
[3]Bolton WK,Innes DJ,Sturgill BC,et al.T-cells and macrophages in rapidly progressive glomerulonephrilis:clinicopathological correlation.Kidney Int,1987,32:869-875.
, http://www.100md.com
[4]唐政,姚小丹,胡伟新,等.寡免疫复合物性新月体肾炎的临床病理分析.中华内科杂志,1997,36:740-743.
[5]Tang Z,Zhou H,Yao XD,et al.The effects of methylprednisolone and cyclophosphamide pulse therapy on renal infiltrating cells in patients with crescentic glomerulonephritis.Chin Med J,1997,110:206-209.
[6]Atkins RC,Nikolic-Paterson DJ,Song Q,et al.Modulators of crescentic glomerulonephfitis.J Am Soc Nephrol,1996,7:2271-2279.
[7]Huang XJ,Holdsworth SR,Tipping S.Evidence for delayed-type hypersensitivity mechanisms in glomerular crescentic formation.Kidney Int,1994,46:69-76.
, http://www.100md.com
[8]刘志红,章海涛.黎磊石,ANCA阳性的狼疮性肾炎.肾脏病与透析肾移植杂志,1998,7:91-96.
[9]Bagchus WM,Hoedaeker PJ,Rozing J,et al.Glomerulonephritis induced by monocloned anti-Thyl-antibodies.A sequential histological and uhrastrual study in the rat.Lab Invest,1986,55:680-685.
[10]Lan HY,Nikoloc-Peterson DJ,Atkins RC.Involvement of activated periglomerular leukocytes in the rapture of Bowmann's capsule and glomerular crescent progression in experimental glomemlonephritis.Lab Invest,1992,67:743-750.
[11]Atkins RC.Interleukin-1 in crescentic glomemlonephritis.Kidney Int,1995,48:576-582.
[12]唐政,姚小丹,胡伟新,等.双冲击疗法治疗寡免疫复合物性新月体肾炎.肾脏病与透析肾移植杂志,1996,5:1-4.
收稿日期：1999-07-23, 百拇医药
单位：210002 南京军区南京总医院 南京大学医学院临床学院肾脏科
关键词：肾小球肾炎；免疫；病理；浸润细胞
中华肾病杂志000413摘 要：目的 研究肾组织各种浸润细胞在新月体肾炎的发病机制中的作用。方法 分析56例各类新月体肾炎患者肾组织中CD68+及PCNA+细胞在各类新月体肾炎患者肾组织中的分布特点，并就它们与肾组织中CD4 及CD8+细胞浸润的关系进行分析探讨。结果 本组新月体肾炎患者肾组织中 CD68+、PCNA+、CD4+及CD8+细胞均明显高于正常供肾组织。在Ⅰ型新月体肾炎患者肾组织中CD68+及PCNA+细胞数高于Ⅱ型及Ⅲ型新月体肾炎患者。肾间质CD4+与肾小球cD68+及PCNA+细胞数呈线性相关者主要表现在Ⅲ型及Ⅰ型新月体肾炎患者。结论 肾间质CD4+与单核细胞及PCNA+细胞呈直线正相关可能为新月体肾炎患者活动与否的一种标志。在狼疮性新月体肾炎患者肾组织中CD4+及CD68+细胞浸润与血管炎及Ⅲ型新月体肾炎患者相似，提示这些患者在新月体的形成中主要由细胞免疫异常所参与。
, http://www.100md.com
The distribution and significance of renal infiltrating cells in patients with diffuse crescentic glomerulonephritis
TANG Zheng ,WU Yan ,HU Weixin
(Department of Nephrology,Jinling Hospital, School of Medicine, Nanjing University,Nanjing 210002,China)
Abstract：Objective To investigate the significance and distribution of renal infiltrating cells including monocytes (CD68+ cell),proliferative nuclear antigen positive cells (PCNA+ cell),CD4+ and CD8+ cells in diffuse crescentic glomerulonephritis (DCGN). Methods 56 patients with DCGN were studied,including 10 case of anti-glomerular basement membrane (GBM) -type I DCGN,26 complex immune-type Ⅱ DCGN,and 20 case of pauci-immune-type Ⅲ DCGN.The glomerular and interstitial infiltrates of CD68+ and PCNA+ cells, and the interstitial infiltrates of CD4+ and CD8+ cells were detected by four-layer PAP method.Results There was a significant increase of renal infiltrating CD68+,PCNA+,CD4+ and CD8+ cells in patients with DCGN compared with that in donors.In patients with type I DCGN,there was a higher of renal infiltrating CD68+ and PCNA+ cells than that in patients with type Ⅱ and Ⅲ DCGN.The glomerular infiltrates of CD68+ and PCNA+ cells correlated with the interstitial infiltrates of CD4+ cells in type Ⅰ or Ⅲ DCGN patients.In lupus DCGN,the numbers of renal infiltrating CD68+ cells PCNA+ cells were similar to vasculitis or type Ⅲ DCGN patients.Conclusions These findings demonstrate that (1) the renal infiltrates of CD68+ and PCNA+ cells play an important role in patients with DCGN.(2)the renal infiltrates of CD4+ cells correlated with the infiltrates of CD68+ and PCNA+ cells may be an active marker of DCGN.(3) the cell-mediated immune pathogenesis may contribute to crescentic formation in lupus DCGN patients.
, http://www.100md.com
Keywords：Glomerulonephritis;Immune;Pathology;Infiltrating cell
参考文献：
[1]胡伟新，黎磊石，陈惠萍，等.微型多动脉炎肾损害的早期诊断.中华肾脏病杂志,1995,11:28-31.
[2]Tang Z,Zhou H,Zhang SL,et al.Significance of anti-neutrophil cytoplasmic antibodies in patients with pauci-immune crescentic glomerulonephritis.Chin Med J,1999,112:1143-1146.
[3]Bolton WK,Innes DJ,Sturgill BC,et al.T-cells and macrophages in rapidly progressive glomerulonephrilis:clinicopathological correlation.Kidney Int,1987,32:869-875.
, http://www.100md.com
[4]唐政,姚小丹,胡伟新,等.寡免疫复合物性新月体肾炎的临床病理分析.中华内科杂志,1997,36:740-743.
[5]Tang Z,Zhou H,Yao XD,et al.The effects of methylprednisolone and cyclophosphamide pulse therapy on renal infiltrating cells in patients with crescentic glomerulonephritis.Chin Med J,1997,110:206-209.
[6]Atkins RC,Nikolic-Paterson DJ,Song Q,et al.Modulators of crescentic glomerulonephfitis.J Am Soc Nephrol,1996,7:2271-2279.
[7]Huang XJ,Holdsworth SR,Tipping S.Evidence for delayed-type hypersensitivity mechanisms in glomerular crescentic formation.Kidney Int,1994,46:69-76.
, http://www.100md.com
[8]刘志红,章海涛.黎磊石,ANCA阳性的狼疮性肾炎.肾脏病与透析肾移植杂志,1998,7:91-96.
[9]Bagchus WM,Hoedaeker PJ,Rozing J,et al.Glomerulonephritis induced by monocloned anti-Thyl-antibodies.A sequential histological and uhrastrual study in the rat.Lab Invest,1986,55:680-685.
[10]Lan HY,Nikoloc-Peterson DJ,Atkins RC.Involvement of activated periglomerular leukocytes in the rapture of Bowmann's capsule and glomerular crescent progression in experimental glomemlonephritis.Lab Invest,1992,67:743-750.
[11]Atkins RC.Interleukin-1 in crescentic glomemlonephritis.Kidney Int,1995,48:576-582.
[12]唐政,姚小丹,胡伟新,等.双冲击疗法治疗寡免疫复合物性新月体肾炎.肾脏病与透析肾移植杂志,1996,5:1-4.
收稿日期：1999-07-23, 百拇医药