目的：探讨儿童紫癜性肾炎（HSPN）肾组织Th1/Th2比值与肾脏微血管损伤的关系。方法：选取32名HSPN患儿为病例组，根据肾脏病理结果分为4个亚组：HSPN Ⅱ级（n=8），Ⅲa级（n=7），Ⅲb级（n=10）及Ⅵ/Ⅴ级（n=7）。5例因肾外伤切除肾组织患者为对照组。免疫组化法检测肾组织INFγ（标记Th1细胞）、IL-4（标记Th2细胞）及CD34（标记微血管）的表达，并进行微血管评分，计算微血管密度（MVD），分析肾脏INFγ、IL-4表达与肾脏病理分级、肾脏微血管评分和MVD之间的关系。结果：与对照组相比，病例组肾组织INFγ表达降低，IL-4表达升高，Th1/Th2比值随着HSPN病理损伤的加重而减小，各级间差异有统计学意义（P<0.05）。与对照组比较，HSPNⅡ级和Ⅲa 级组MVD显著增加，但Ⅳ/Ⅴ级组MVD显著减少（P<0.05）。与对照组和HSPNⅡ级组比较，HSPNⅢa级、Ⅲb级以及Ⅳ/Ⅴ级组肾脏微血管评分明显增加，且随病理分级的增加，肾脏微血管评分逐渐增加，各级间差异有统计学意义（P<0.05）。肾组织Th1/Th2比值与微血管密度变化呈负相关（r=-0.921，P<0.01）。结论：Th1/Th2比值降低可能参与了HSPN肾脏微血管损伤。
Abstract
OBJECTIVE: To explore possible correlations between renal Th1/Th2 ratio and renal microvascular injury in children with Henoch-Schonlein purpura nephritis (HSPN). METHODS: Thirty-two children with HSPN were enrolled. They were classified into four groups by renal pathology: HSPN class II (n=8), HSPN class IIIa (n=7), HSPN class IIIb (n=10) and HSPN class IV/V (n=7). Five patients undergoing nephrectomy due to trauma were used as the controls. INFγ, IL-4 and CD34 in the renal tissues were measured by immunohistochemical analysis. INFγ was used as a marker of Th1, IL-4 was used as a marker of Th2 and CD34 was used as a marker of microvessel. The renal microvessel density was evaluated according to the Weidner standard. The relationships among the local Th1/Th2 ratio, renal pathological grade, microvessel score and microvessel density were studied. RESULTS: Immunohistochemical analysis showed a lower expression of INFγ and a higher expression of IL-4 in the HSPN groups than in the control group. The local Th1/Th2 ratio in the HSPN groups decreased and correlated significantly with the renal pathological grade. There were significant differences among four HSPN subgroups (P<0.05). Compared with the control group, the renal microvessel density in the HSPN class II and class IIIa groups increased significantly (P<0.05), but it decreased in the HSPN class IV/V group (P<0.05). The renal microvessel scores in the HSPN class IIIa, class IIIb and class IV/V groups increased significantly compared with those in the control and the HSPN classⅡ. The increased renal microvessel scores were associated with more severe renal pathological changes. A negative correlation was found between the local Th1/Th2 ratio and the microvessel density in kidneys (r=-0.921, P<0.01). CONCLUSIONS: The decrease of Th1/Th2 ratio in kidneys might be responsible for renal microvascular injury in children with HSPN.
关键词
紫癜性肾炎 /
Th1/Th2比值 /
微血管损伤 /
儿童
Key words
Henoch-Schonlein purpura nephritis /
Th1/Th2 ratio /
Microvascular injury /
Child
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