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目的:观察肥大细胞在抗肾小球基膜(GBM)肾炎患者肾脏浸润中的临床意义。方法:选取38例经肾活检确诊为抗GBM肾炎的患者,收集其临床病理资料。通过免疫组化染色检测肾组织中肥大细胞(类胰蛋白酶)。根据浸润肾肥大细胞计数将患者分为组1(肥大细胞<50个/mm2,n=18)和组2(肥大细胞≥50个/mm2,n=20)。比较两组患者临床症状、实验室检查和病理指标的差异,并对肥大细胞浸润和临床与病理指标之间的相关性进行分析。结果:与组1相比,组2患者病程较长、年龄较大、发生肉眼血尿者较多、少尿/无尿比例较高,蛋白尿、镜下血尿、低蛋白血症较轻,而贫血程度较重、抗GBM抗体滴度较高。同时,组2患者肾损伤程度较重,血清肌酐(SCr)(791±324μmol/L vs 412±241μmol/L,P<0.001),尿视黄醇结合蛋白(RBP)(29.8±13.9 mg/dl vs 15.7±11.5 mg/dl,P=0.005)水平较高,尿渗透压较低[285±82.37 mOsm/(kg·H2O)vs 429±359 mOsm/(kg·H2O),P=0.001]。组2患者肾小球硬化和包囊破裂的比例亦较高,间质纤维化程度较重,但两组之间无显著差异;纤维性/纤维细胞新月体比例较高(66.7%±21.9%vs 47.0%±33.6%,P=0.037),细胞性新月体比例较低,但无显著差异。组2患者肾组织间质还可见较多炎性细胞浸润(包括CD4+、CD8+及CD68+细胞)。其中CD8+细胞(180个/mm2vs 268个/mm2,P=0.045)及CD68+细胞(534个/mm2vs 792个/mm2,P=0.017)浸润在两组之间存在显著差异。此外,肥大细胞与新月体和肾小管间质炎症细胞(包括CD68+细胞和T淋巴细胞)的数量显著相关。结论:抗GBM肾炎患者肾脏肥大细胞浸润和慢性病变相关。
Objective: To observe the clinical significance of mast cells in renal infiltration in anti-glomerular basement membrane (GBM) nephritis patients. Methods: Thirty-eight patients diagnosed as having anti-GBM nephritis by renal biopsy were selected and their clinicopathological data were collected. Mast cells (tryptase) in renal tissue were detected by immunohistochemical staining. Patients were divided into Group 1 (mast cells <50 cells / mm2, n = 18) and Group 2 (mast cells> 50 cells / mm2, n = 20) according to infiltrating renal mast cell count. The differences of clinical symptoms, laboratory tests and pathological parameters between the two groups were compared. The correlation between mast cell infiltration and clinicopathological parameters was also analyzed. Results: Compared with group 1, patients in group 2 had longer duration, older age, more gross hematuria, higher oliguria / anuria, less proteinuria, microscopic hematuria and hypoalbuminemia Anemia to a higher degree of anti-GBM antibody titers higher. At the same time, patients in Group 2 had a greater degree of renal injury with serum creatinine (SCr) (791 ± 324 μmol / L vs 412 ± 241 μmol / L, P <0.001), urinary retinol binding protein (RBP) vs 15.7 ± 11.5 mg / dl, P = 0.005), with lower urine osmolality [285 ± 82.37 mOsm / (kg · H2O) vs 429 ± 359 mOsm / (kg · H2O), P = 0.001]. The ratio of glomerular sclerosis and cystic rupture was also higher in group 2 than in group 2, and the degree of interstitial fibrosis was higher, but there was no significant difference between the two groups. The proportion of crescent of fibroblasts / fibroblasts was higher (66.7% ± 21.9 % vs 47.0% ± 33.6%, P = 0.037), the proportion of cellular crescent was lower but no significant difference. There were also more infiltration of inflammatory cells (including CD4 +, CD8 + and CD68 + cells) in the renal interstitium in group 2 patients. There were significant differences in the infiltration of CD8 + cells (180 cells / mm2 vs 268 cells / mm2, P = 0.045) and CD68 + cells (534 cells / mm2 vs 792 cells / mm2, P = 0.017) between the two groups. In addition, mast cells were significantly associated with the number of crescentic and tubulointerstitial inflammatory cells, including CD68 + cells and T lymphocytes. Conclusion: There is a correlation between renal mast cell infiltration and chronic disease in patients with GBM nephritis.