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目的:了解不同亚型IgA肾病(IgA nephropathy,IgAN)患者肾组织中肥大细胞的分布及其与各种疾病指标的相关性,全面探讨肥大细胞在IgAN中的可能病理意义。方法:选取包括大量蛋白尿型、反复发作肉眼血尿型、高血压型、无症状尿检异常型、血管炎型在内的IgAN患者共110例,根据肾组织肥大细胞特异性高表达C3aR的特点,利用免疫组化的方法对所有患者的肾穿刺活检标本切片进行C3aR免疫组化染色,计数各切片C3aR强阳性细胞数,同时测量切片面积,计算各患者肾组织肥大细胞分布密度(同时选取正常供肾15例作为对照);在此基础上,利用统计学方法,进行肾组织肥大细胞密度与包括血、尿生化指标,肾小管间质相对面积和肾组织炎症细胞密度在内的各种病理指标进行相关性分析,探讨肥大细胞在IgAN中的病理意义。结果:(1)肥大细胞广泛存在于各亚型IgAN患者肾组织中;与正常对照相比,各亚型IgAN患者肾组织中的肥大细胞数均有明显的增加。(2)总的来看,肾组织中肥大细胞数与血肌酐和血CystatinC水平、尿视黄醇结合蛋白(RBP)和尿溶菌酶水平及间质炎症细胞数量,肾小管间质相对面积具显著相关性,而与尿C3、尿α2巨球蛋白(α2-MG)和24h尿蛋白水平及尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)水平则无明显相关性。(3)不同亚型IgAN肾组织肥大细胞与各种病理指标的相关性有明显差异,其中,反复发作肉眼血尿型与其他亚型的差异性最明显。结论:肥大细胞很可能参与了包括大量蛋白尿型、反复发作肉眼血尿型、无症状尿检异常型、高血压型和血管炎型在内的各种亚型IgAN的病理过程。肥大细胞在不同亚型IgAN中的地位和作用机制也可能存在差异。
Objective: To investigate the distribution of mast cells in renal tissues of patients with different subtypes of IgA nephropathy (IgAN) and its correlation with various disease indexes, and to explore the possible pathological significance of mast cells in IgAN. Methods: A total of 110 IgAN patients including massive proteinuria type, recurrent gross hematuria type, hypertension type, asymptomatic urinalysis type and vasculitis type were selected. According to the characteristics of mast cell-specific C3aR expression in renal tissues, Immunohistochemistry was used to detect the C3aR immunohistochemical staining of all the specimens of renal biopsy specimens. The numbers of C3aR positive cells in each section were counted. The area of the section was measured and the distribution density of mast cells in each group was calculated Kidney 15 as a control); on this basis, the use of statistical methods, renal tissue mast cell density and including blood and urine biochemical indicators, the relative area of tubulointerstitial and renal tissue inflammatory cell density, including a variety of pathological indicators Correlation analysis, to explore the pathological significance of mast cells in IgAN. Results: (1) Mast cells were widely found in renal tissues of various subtypes of IgAN patients. Compared with normal controls, the numbers of mast cells in renal tissues of all subtypes of IgAN patients were significantly increased. (2) In general, the number of mast cells in renal tissue correlated with serum creatinine and serum Cystatin C levels, urinary retinol binding protein (RBP) and urinary lysozyme levels, interstitial inflammatory cells, and the relative area of tubulointerstitial There was no significant correlation between urinary C3, urinary α2-macroglobulin (α2-MG), 24-hour urinary protein and urine N-acetyl-β-D-glucosaminidase (NAG) (3) The correlation between mast cells in different subtypes of IgAN nephridial tissue and various pathological parameters were significantly different, among them, the recurrence of gross hematuria and other subtypes was the most obvious. Conclusion: Mast cells are likely to be involved in the pathological processes of various subtypes of IgAN, including massive proteinuria, recurrent gross hematuria, asymptomatic urinalysis, hypertension and vasculitis. Mast cells in different subtypes of IgAN status and mechanism of action may be different.