摘要目的 探讨LN患者肾组织淋巴细胞亚群浸润与足细胞损伤的关系,为LN患者足细胞损伤的机制提供理论依据.方法 收集确诊为LN的患者30例,根据2000年SLEDAI分为活动组(19例)和非活动组(11例),同时收集正常对照组10例.留取患者的血标本和肾组织标本;收集分析全部患者的临床和病理资料;免疫组织化学方法检测肾组织中T细胞(CD4+、CD8+细胞)和B细胞(CD20+细胞)浸润;免疫荧光技术检测肾组织nephrin蛋白表达;Pearson法分析淋巴细胞亚群浸润与尿蛋白定量(24 h)、肾组织nephrin表达的相关性.结果 ①与正常对照组相比,LN患者尿蛋白定量(24 h)明显升高[(2.86±1.37)24 h与(0.10±0.22)g/24 h],肾脏病理示:肾组织有明显的炎性细胞浸润,足细胞足突广泛融合甚至消失;且LN活动组患者尿蛋白定量(24h)较非活动组患者明显升高[(3.91±1.45)24 h与(1.77±0.69) g/24 h;F=24.15,P＜0.05],炎症细胞浸润和足细胞足突融合明显严重.②与正常对照组相比,LN患者肾组织nephrin表达明显减少;肾组织中CD4+、CD8+和CD20+细胞浸润明显,主要呈簇状或散在分布于肾间质,且LN活动组较非活动组患者CD4+[98±13与40±12(个/肾小球);F=240.18,P＜0.05]、CD8+[109.0±16.4与53.3±12.1(个/肾小球);F=210.40,P＜0.05]和CD20+[149.4±1.4与82.6±13.3(个/肾小球);F=544.30,P＜0.05],淋巴细胞浸润更加明显;③LN患者肾组织中CD4+、CD8+和CD20+细胞浸润计数分别与尿蛋白定量(24 h)呈正相关(r=0.688、0.748、0.702;P＜0.01);与肾组织nephrin表达呈负相关(r=-0.623、-0.793、-0.693;P＜0.01).结论 LN患者肾组织淋巴细胞亚群浸润与足细胞损伤有密切关系,肾组织淋巴细胞浸润可能是LN患者足细胞损伤的重要机制之一.

abstractsObjective To investigate the relationship between the infiltration of lymphocytes in renal tissues and podocytes injury in patients with lupus nephritis (LN),and provide the evidence of mechanism of podocytes injury in LN.Methods Thirty cases of biopsy proven LN patients were enrolled into the study,10 cases were selected as a the controls.The clinical and pathological data and renal tissues were collected.The infiltration of T lymphocytes (CD4+,CD8+ cells) and B lymphocytes (CD20+ cells) in renal tissues were detected by immunohistochemical method.The nephrin expression was detected by immunofluorescence.The relationship between CD4+,CD8+,CD20+ cells in renal tissues and 24 h UP,nephrin expression were analyzed by Pearson's correlation analysis,respectively.Results ① Compared with the control group,the 24 h UP was increased [2.86±1.37 vs 0.10±0.22 (g/24 h)];the infiltrations of inflammatory cells were increased significantly,the podocytes injury could be observed,combined with effacement of podocytes foot processes or disappeared in the LN group.Moreover,the increase of 24 h UP of active LN group was more evident than that in the inactive group [3.91 ±1.45 vs 1.77±0.69 (g/24 h),F=24.15,P＜0.05],and the infiltration of inflammatory cellsand effacement of podocytes foot processes were more severe in the active LN group.②Compared with the control group,the nephrin expression decreased and the infiltration of CD4+,CD8+ and CD20+ cells in the renal tissues increased significantly,which was mainly aggregated in renal interstitial tissue.And In addition,CD4+ [98±13 vs 40±12 (cells/glomerulus),F=240.18,P＜0.05],CD8+[109.0±16.4 vs 53.3±12.1(cells/glomerulus),F=210.40,P＜0.05] and CD20+ [149.4±1.4 vs 82.6±13.3 (cells/glomerulus),F=544.30,P＜0.05] cells of the active LN group were more remarkable than that in the inactive group.③ The Pearson correlation analysis showed that CD4+,CD8+ and CD20+ cells in renal tissues were positively correlated with 24 h UP (r=0.688,0.748,0.702;P＜0.01),and were negatively correlated with nephrin expression (r=-0.623,-0.793,-0.693;P＜0.01).Conclusion The infiltrations of CD4+,CD8+ and CD20+cells in renal tissues are very closely related with podocytes injury in patients with LN,and the infiltration of lymphocytes may be an important mechanism for podocytes injury in LN patients.