狼疮肾炎患者肾小球外补体C1q沉积的临床病理意义
Clinicopathological significance of extraglomerular complement C1q deposition in lupus nephritis patients
杨晓青 1黄岩杰 1杨月丽 1毕亮亮 1张秋爽 1丁樱 1任献青 1翟文生1
作者信息
- 1. 河南中医药大学儿科医学院,郑州 450046;河南中医药大学第一附属医院肾脏病理实验室,郑州 450000
- 折叠
摘要
目的 了解狼疮肾炎(lupus nephritis,LN)患者肾小球外补体C1q的沉积情况,探讨其临床病理意义,为LN肾小管间质损伤机制提供免疫学证据.方法 该研究为横断面研究.收集2019年3月1日至2023年6月30日河南中医药大学第一附属医院经肾活检证实的LN患者的临床资料.石蜡切片直接免疫荧光法检测肾小球外即肾小管基底膜、肾小管周毛细血管和肾间质小动脉C1q的沉积,连续切片分析C1q表达与相应组织病变的关系.Pearson相关分析法或Spearman秩相关分析法分析C1q表达水平与肾组织病理评分(活动性肾小管间质指数、活动性肾小球指数、活动性指数、慢性肾小管间质指数、慢性肾小球指数、慢性指数)、肾损伤临床指标(24 h尿蛋白量、尿α1微球蛋白、尿N-乙酰β-D-葡萄糖苷酶、血肌酐)的相关性.结果 该研究纳入LN患者71例,年龄(20.83± 11.77)岁(7～48岁),其中男性14例(19.72％),女性57例(80.28％).LN病例分型Ⅱ型6例,Ⅲ型21例,Ⅳ型18例,Ⅴ型8例,Ⅲ+Ⅴ型12例,Ⅳ+Ⅴ型6例.石蜡切片分析结果显示,肾小管基底膜和/或肾小管周毛细血管和/或肾间质小动脉C1q阳性60例(84.51％),以肾小管基底膜阳性率最高(50例,70.42％).C1q在肾小管基底膜呈散在或局灶沉积44例(61.97％).C1q在肾小管周毛细血管呈散在或局灶沉积32例(45.07％).肾小管基底膜C1q阳性比例以LN LN Ⅳ型(15/18)最高.肾小管周毛细血管C1q阳性比例以LN Ⅱ型(5/6)最高.肾组织连续切片结果显示,C1q主要表达在肾小管间质炎症病变区域,肾小管萎缩区域无C1q阳性表达.相关性分析结果显示,肾小管基底膜C1q阳性百分比与活动性肾小管间质指数(r=0.640,P＜0.001)、尿α1微球蛋白(r=0.573,P＜0.001)、尿N-乙酰-β-D-葡萄糖苷酶(r=0.404,P=0.008)及血肌酐(r=0.399,P=0.001)均呈正相关,与其他肾组织病理评分和24 h尿蛋白量均无相关性.C1q肾小管周毛细血管与24 h尿蛋白量、尿α1微球蛋白、尿N-乙酰β-D-葡萄糖苷酶、血肌酐和肾组织病理评分均无相关性.结论 C1q在肾小管基底膜沉积可能是肾小管间质损伤的原因之一,建议在常规肾脏病理诊断中予以标注.
Abstract
Objective To investigate the extraglomerular deposition of C1q in patients with lupus nephritis(LN)and explore its clinicopathological significance,and to provide immunological evidence for the mechanism of renal tubulointerstitial injury in LN.Methods It was a cross-sectional study.The clinical data of patients with LN confirmed by renal biopsy in the First Affiliated Hospital of Henan University of Chinese Medicine from March 1,2019 to June 30,2023 were collected.Extraglomerular deposition of C1q,including tubular basement membranes(TBMs),peritubular capillaries and interstitial arterioles,was detected by direct immunofluorescence method in paraffin sections,and the relationship between C1q expression and corresponding tissue lesions was analyzed in successive sections.Pearson correlation coefficient or Spearman correlation coefficient was used to analyze the correlation between C1q expression level and renal histopathologic scores(active tubular interstitial index,active glomerular index,active index,chronic tubular interstitial index,chronic glomerular index,chronic index),clinical indexes(24-hour urinary protein,urinary alpha-1 microglobulin,urinary N-acetyl-β-D-glucosidase and serum creatinine).Results A total of 71 patients with LN were included in the study,including 14 males(19.72％)and 57 females(80.28％),with age of(20.83±11.77)years old(7-48 years old).The paraffin sections analysis showed that 60 patients(84.51％)had extraglomerular deposits of C1q.C1q deposits occurred in the TBMs and/or peritubular capillaries and/or interstitial arterioles,with the highest positive rate(50 patients,70.42％)in TBMs.Forty-four patients(61.97％)had scattered or focal C1q deposition in the TBMs.Thirty-two patients(45.07％)had scattered or focal C1q deposition in peritubular capillaries.The positive proportion of C1q in TBMs was the highest in typeⅣ of LN(15/18).The positive proportion of C1q in peritubular capillaries was the highest in type Ⅱof LN(5/6).The continuous sections of kidney tissues showed that C1q was mainly expressed in the acute tubulointerstitial inflammation area,and no positive expression was found in the tubule atrophy area.The correlation analysis showed that C1q deposition level in TBMs was positively correlated with active tubular interstitial index(r=0.640,P＜0.001),urinary alpha-1 microglobulin(r=0.573,P＜0.001),urinary N-acetyl-β-D-glucosaminidase(r=0.404,P=0.008)and serum creatinine(r=0.399,P=0.001).There was no correlation between the positive percentage of C1q in peritubular capillaries and 24 h urinary protein,urinary alpha-1 microglobulin,urinary N-acetyl-β-D-glucosidase,serum creatinine and renal histological scores.Conclusion C1q deposition in TBMs may be one of the causes of tubulointerstitium injury,it is recommended to be marked in the routine renal pathological diagnosis.
关键词
狼疮肾炎/C1q/肾小管基底膜/肾小管周毛细血管Key words
Lupus nephritis/C1q/Tubular basement membranes/Peritubular capillary引用本文复制引用
基金项目
河南省中医药学科领军人才项目(20218号)
河南省科学技术厅中原科技创新领军人才项目(234200510028)
河南省卫生健康委员会国家中医临床研究基地科研专项(2021JDZY064)
出版年
2024
NETL
NSTL
万方数据