摘要目的 比较4种常见新月体性肾小球肾炎(CGN)中新月体细胞成分及其细胞增殖的变化.方法 采用免疫组织化学(EnVision法)检测45例CGN,包括抗肾小球基底膜型CGN 10例、新月体型IgA肾病12例、寡免疫复合物抗中性粒细胞胞质抗体相关性CGN 12例、新月体型狼疮性肾炎11例,新月体中细胞特异性标志物细胞角蛋白(CK,壁层上皮细胞)、CD68(巨噬细胞)、巢蛋白(足细胞)和podocalyxin(成熟足细胞)、CD3(T淋巴细胞)、CD15(中性粒细胞)以及增殖细胞核抗原(PCNA)的表达并进行计数.结果 CGN中细胞新月体主要细胞构成为壁层上皮细胞11.4(0.0,95.0)%、巨噬细胞8.0(0.0,35.0)%和足细胞5.5(0.0,22.0)%,其构成比在4种不同类型CGN组间比较,差异均有统计学意义(P值均＜0.01);细胞新月体中约50%细胞为各种标志物均呈阴性的"裸细胞";podocalyxin阳性的成熟足细胞比例0.5(0.0,9.6)%远小于巢蛋白阳性的足细胞5.5(0.0,22.0)%;PCNA阳性细胞比例为44.7(16.7,83.3)%,并可见PCNA和巢蛋白、PCNA和CK及PCNA和CD68共表达细胞.结论不同CGN细胞新月体的形成机制可能不完全相同;壁层上皮细胞、足细胞、巨噬细胞主动参与了细胞新月体形成;细胞新月体中足细胞可能是发生了不同程度的退分化,其中部分"裸细胞"可能来源于退分化的足细胞.

abstractsObjective To examine the cellular components at different stages of the crescent formation in four most common types of human crescentic glomerulonephritis ( CGN ) , including anti-GBM disease ( GBM-CGN ), crescentic IgA nephropathy ( IgA-CGN ), ANCA associated panci-immune CGN (ANCA-CGN) and crescentic lupus glomeruionephritis(LN-CGN). Methods Renal biopsy specimens of patients with GBM-CGN (n = 10), IgA-CGN(n = 12), ANCA-CGN (n = 12), and LN-CGN(n = 11) were selected. Immunohistochemistry was adopted to identify the cellular components using different cell markers including cytokeratin (PEC), CD68 (macrophage), nestin (podocyte), podocalyxin (podocyte), CD3 (lymphocyte), CD15 (neutrophil) and PCNA. Results There were different subtypes of cell components identified during the formation of a cellular crescent in 4 different types of human CGN. Mainly of PEC 11.4 (0.0, 95.0)%, macrophage 8.0(0.0, 35.0)% and podocyte 5.5(0.0, 22.0)% and their constitutive percentages were different among various CGNs ( P ＜ 0.01 ). In all the CGNs studied, there were 50% of cells were negative to all the cell markers adopted for this expeiment. Podocalyxin positive cells 0.5 (0.0,9.6)% were significantly less than nestin positive cells 5.5 (0.0, 22.0)% in all CGNs. PCNA positive cells were 44.7( 16.7, 83.3)% in the cellular crescent of all CGNs and co-localized with nestin (38/45 cases), CK(42/45 cases) or CD68 (24/45 cases). Conclusions PEC, macrophage and podocyte might play important roles in the formation of crescents. The staining disparity of nestin and podocalyxin indicates that podocyte dedifferentiation may occur during the crescent formation. PEC, podocytes and macrophages may participate in the formation of crescent in common CGNs through active cellular proliferation.