Daniel L, Sichez H, Giorgi R, Dussol B, Figarella-Branger D, Pellissier J F, Berland Y
Departments of Pathology and Statistics, Timone Hospital, Marseilles, France.
Kidney Int. 2001 Dec;60(6):2215-21. doi: 10.1046/j.1523-1755.2001.00055.x.
To assess the prognostic value of tubular lesions and cell adhesion molecules' expression, a retrospective study with immunohistochemistry was performed on 152 patients presenting lupus nephritis from January 1985 to December 1999.
The following clinical parameters were recorded: age, sex, race, time of systemic lupus erythematosus (SLE) diagnosis, time of the biopsy, proteinuria, creatininemia, and renal function at the end of follow-up. All biopsies were re-evaluated according to a tubular grading, an inflammatory grading, the percentage of sclerosed glomeruli, the percentage of crescents, and the current WHO classification. Immunohistochemistry was performed with anti-CD40, anti-CD44, and anti-intercellular adhesion molecule-1 (anti-ICAM-1) antibodies.
Patients were 136 women (89.5%) and 16 men with a mean age of 31.2 years +/- 12.8 at the time of biopsy. The mean follow-up period was 94.3 months +/- 64.1. Eighty-eight biopsies (58%) showed various degrees of tubular atrophy. Males (P = 0.001) and tubular grading (P = 0.0001) were linked with renal survival in univariate and multivariate analysis. CD40 (P = 0.01) and ICAM-1 (P = 0.001) tubular expressions were linked with renal survival. ICAM-1 tubular expression provided additional information for the prognosis of the patients with biopsies showing tubular atrophy (P = 0.005) or not (P = 0.05).
Our study shows that tubular lesions are good indicator of lupus nephritis outcome. Furthermore, tubular expression of cell adhesion molecules like ICAM-1 and CD40 also serves to predict the outcome.
为评估肾小管病变及细胞黏附分子表达的预后价值，对1985年1月至1999年12月期间就诊的152例狼疮性肾炎患者进行了一项免疫组织化学回顾性研究。
记录以下临床参数：年龄、性别、种族、系统性红斑狼疮（SLE）诊断时间、活检时间、蛋白尿、血肌酐水平以及随访末期的肾功能。所有活检标本均根据肾小管分级、炎症分级、硬化肾小球百分比、新月体百分比以及当前的世界卫生组织分类标准进行重新评估。采用抗CD40、抗CD44和抗细胞间黏附分子-1（抗ICAM-1）抗体进行免疫组织化学检测。
活检时患者中有136名女性（89.5%）和16名男性，平均年龄为31.2岁±12.8岁。平均随访期为94.3个月±64.1个月。88例活检标本（58%）显示出不同程度的肾小管萎缩。在单因素和多因素分析中，男性（P = 0.001）和肾小管分级（P = 0.0001）与肾脏存活率相关。CD40（P = 0.01）和ICAM-1（P = 0.001）在肾小管中的表达与肾脏存活率相关。ICAM-1在肾小管中的表达为活检显示有肾小管萎缩（P = 0.005）或无肾小管萎缩（P = 0.05）的患者的预后提供了额外信息。
我们的研究表明，肾小管病变是狼疮性肾炎预后的良好指标。此外，ICAM-1和CD40等细胞黏附分子在肾小管中的表达也有助于预测预后。
