巨噬细胞在IgA肾病患者肾脏中的浸润及其与肾纤维化的关系
Macrophage infiltration in the kidney of patients with IgA nephropathy and its relationship with renal fibrosis

摘要：目的 分析巨噬细胞在IgA肾病患者肾脏中的浸润程度及其与肾纤维化的关系，探讨巨噬细胞在IgA肾病中作用。方法 收取40例肾穿刺活检病理为IgA肾病患者的肾组织标本及11例外伤性肾损伤后肾切除患者的肾组织标本，石蜡包埋切片，应用巨噬细胞标记物CD68进行免疫组织化学染色；采用Masson染色观察肾纤维化程度；随机选取不同视野，统计分析不同病理级别(Lee氏分级)的IgA肾病患者巨噬细胞浸润程度和肾纤维化程度，并对纤维化程度和巨噬细胞浸润程度进行相关性分析。结果 IgA肾病患者的肾巨噬细胞浸润面积随病理级别的加重而逐渐增加，Ⅱ级～Ⅴ级的巨噬细胞浸润面积比例的中位数(四位分数间距)依次为0.153%(0.058%)、0.211%(0.101%)、0.324%(0.132%)、0.533%(0.071%)，正常肾组织的巨噬细胞浸润面积比例为0.043%(0.04%)，各组间具有统计学差异(P<0.01)。IgA肾病患者的纤维化程度和巨噬细胞浸润程度存在显著正相关(r=0.901，P<0.01)。结论 IgA肾病患者肾组织中巨噬细胞浸润程度随病理分级加重，并与肾纤维化程度呈正相关，提示巨噬细胞在IgA肾病发生发展中具有一定的作用。
ABSTRACT: Objective To analyze macrophage infiltration in the kidney of patients with IgA nephropathy and its relationship with renal fibrosis so as to explore the role of macrophages in the development of IgA nephropathy.Methods The kidney specimens from 40 patients with IgA nephropathy were obtained by diagnostic renal biopsy. The normal kidney specimens were obtained from 11 patients with nephrectomy after renal trauma. The specimens were treated by paraffin embedding and sliced for immunohistochemical staining with CD68 antibody which labelled macrophages. The level of CD68 positive staining in different grades of IgA nephropathy was analyzed by calculating staining area in randomly selected visual fields. Masson staining was used to evaluate the severity of renal fibrosis; the relationship between renal fibrosis and macrophage infiltration was analyzed. Results The level of macrophage infiltration in the kidney of patients with IgA nephropathy increased with the grade of IgA nephropathy. The ratios of the area in infiltrated macrophages to the area of kidney from grade Ⅱ to grade Ⅴ were 0.153% (0.058%), 0.211% (0.101%), 0.324% (0.132%) and 0.533% (0.071%); the ratio in normal kidney was 0.043% (0.04%). There were significant differences between the groups (P<0.01). There was a positive correlation between renal fibrosis and macrophage infiltration with the correlation coefficient of r=0.901 (P<0.01).Conclusion Renal macrophage infiltration becomes more severe with the increased grade of IgA nephropathy, and it is positively correlated with renal fibrosis. It is indicated that macrophages are involved in the development of IgA nephropathy