【摘要】 目的　观察狼疮肾炎肾间质浸润的白细胞类型与肾功能损害进展的关系。方法　检测 4 0例狼疮肾炎患者 2 4h尿蛋白定量、血肌酐 ,随即进行肾活检及免疫组织化学检测 ,2 1例患者进行二次肾活检。结果　狼疮肾炎患者首次肾活检时显示T淋巴细胞与单核细胞所占比例差异无显著性 ,而第 2次肾活检时以单核细胞为主。首次肾活检时间质浸润的淋巴细胞CD4 + /CD8+ 较正常对照组增加 ,第 2次肾活检时CD4 + /CD8+ 低于正常对照组。第 2次肾活检时显著间质浸润的发生率由首次活检时的 4 7 5 %升至 1 0 0 %。浸润白细胞总数与血肌酐水平呈正相关 ,其中T细胞、中性粒细胞亦与血肌酐呈正相关 ,单核细胞与血肌酐无显著相关性。结论　重复肾活检可发现更多病例肾间质损害 ,狼疮肾炎肾间质的主要浸润细胞类型呈疾病进展阶段依赖性 ,CD4 + T细胞在间质损伤机制中起始发作用 ,CD8+ T细胞的作用可能是继发的 ,长期的蛋白尿可能对CD8+ 细胞的浸润有激发作用。更多还原

【Abstract】 Objective To investigate the type of renal interstitial leucocyte infiltration in lupus nephritis (LN) patients and its correlation with renal functional damage.Methods Forty patients with lupus nephritis were studied.Twenty four hours of urine protein and serum creatine were evaluated just before renal biopsy followed with immunohistochemical examination.The second biopsy was performed in 21 patients.Results There were no significant differences between the proportions of T lymphocytes and monocytes in the first biopsy patients.The infiltrated cells were mainly monocytes in the second biopsy patients.The infiltrated CD4 + and CD8 + T lymphocytes were found in renal interstitium in all patients.The value CD4 +/CD8 + was higher in the first biopsy patients compared with the control,while it was lower in the second biopsy patients.The incidence of interstitium infiltration was markedly increased from 47 5% at the first biopsy time to 100% at the second time.The amount of infiltrated leucocytes was positively correlated with the level of serum creatine.The amounts of T lymphocytes and neutrophils were both positively correlated with the level of serum creatine.Monocytes had no relationship with the level of serum creatine. Conclusion It suggests that the type of infiltrats leucocyte in renal interstitium of LN patients may change according to the processes of the disease.CD4 + T lymphocytes may initiate the deterioration of renal function in LN patients, whereas the infiltrated CD8 + T lymphocytes may be activated by the long term proteinuria .更多还原