不同类型慢性肾脏病患者肾组织巨噬细胞浸润及与肾纤维化的关系
Renal macrophage infiltration in patients with different types of chronic kidney diseases and its relationship with renal fibrosis

摘要：目的 分析不同类型肾疾病患者的肾脏巨噬细胞(MΦ)浸润情况，探讨肾脏M？加肷龉δ芩鸷？及患者预后的关系。方法 取肾脏病临床患者的肾穿刺活检标本110例和11例正常肾组织标本，石蜡包埋切片，用MΦ标记物CD68免疫染色，随机选取视野，计算每例患者肾脏MΦ浸润程度，并对肾脏MΦ浸润程度与肾功能及肾组织纤维化进行相关性分析。结果 不同类型肾疾病患者的肾组织均可见MΦ浸润，主要发生在肾小管间质区，MΦ浸润程度自高向低依次为狼疮性肾炎、系膜增生性肾炎伴慢性间质或血管病变、IgA肾病、糖尿病肾病、紫癜性肾炎、膜性肾病、系膜增生性肾炎，除系膜增生性肾炎外的其余各组均较正常对照组明显升高(P<0.01)。各类型肾疾病的肾脏M？冀？润程度与患者血液的肌酐、尿素氮、胱抑素C水平呈正相关，与肾小球滤过率显著负相关，与肾脏纤维化程度呈正相关(P<0.01)。结论 肾脏MΦ浸润程度在不同类型肾疾病中存在统计学差异，与患者肾功能损害程度、肾脏纤维化程度呈正相关，提示MΦ与肾疾病的类型和转归密切相关。
ABSTRACT: Objective To analyze renal macrophage infiltration in patients with different types of kidney diseases and its relationship with renal fibrosis so as to explore the relationship of renal macrophages with kidney damage and prognosis. Methods The kidney specimens from 110 patients with diagnostic nephrocentesis and 11 control patients without kidney diseases were treated by paraffin embedding and sliced for immunohistochemical staining with CD68 antibody that labelled macrophages. The levels of CD68 positive staining in each specimen were analyzed by calculating staining area in randomly selected visual fields. Masson-trichrome staining was used to evaluate the severity of renal fibrosis, and the correlation between renal fibrosis and macrophage infiltration was analyzed. Results Macrophage infiltration occurred and was distributed mostly in the tubulointerstitial region in all the specimens from the 110 patients. According to the degree of renal macrophage filtration, the different types of renal diseases in this study were in the descending order as follows: lupus nephritis, mesangial proliferative nephritis with chronic interstitial or vascular lesions, IgA nephropathy, diabetic nephropathy, purpura nephritis, membranous nephropathy, and mesangial proliferative nephritis. The degree of renal macrophage infiltration in the groups of the disease mentioned above except the group of mesangial proliferative nephritis was significantly higher than that in the control group (P<0.01). The degree of renal macrophage infiltration had a significantly positive correlation with blood creatinine, urea nitrogen, and cystatin C. It had a significantly negative correlation with glomerular filtration rate but a significantly positive correlation with renal fibrosis (P<0.01). Conclusion Renal macrophage filtration shows significant differences among different renal diseases and is correlated positively with the degree of renal function impairment and renal fibrosis. It indicates that macrophages are involved in renal damage process and play different roles in the development of different renal diseases