Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
Am J Med Sci. 2010 Dec;340(6):474-80. doi: 10.1097/MAJ.0b013e3181f0768e.
This study aims to investigate the evidence of neutrophil infiltration in renal tissue from patients with antineutrophil cytoplasmic antibodies (ANCA)-negative pauci-immune crescentic glomerulonephritis (CrGN), and a comparison with their ANCA-positive counterparts was performed.
Renal biopsy specimens from 31 patients with pauci-immune CrGN were collected. Twelve patients were ANCA negative, and 19 patients were ANCA positive. Neutrophil infiltration was investigated by staining of 2 markers, CD15 and myeloperoxidase (MPO), using immunohistochemistry.
Positive-stained cells of CD15 (CD15) and MPO (MPO+) were mainly located in glomeruli with cellular crescents and segmental fibrinoid necrotic lesions and in periglomerular area of cellular crescents, especially at the area of ruptured Bowman capsule. Scanty positive staining was found in normal renal tissue. The number of CD15 cells in the glomeruli and periglomerular area was significantly higher in ANCA-negative group than in ANCA-positive group (in glomeruli: 2.70 ± 1.61 versus 1.38 ± 0.85, P = 0.019; in periglomerular area: 4.35 ± 4.36 versus 1.48 ± 1.67, P = 0.047). The number of MPO+ cells in the periglomerular area was also significantly higher in ANCA-negative group than that in ANCA-positive group.
Renal neutrophil infiltration might play a pathogenic role in ANCA-negative pauci-immune CrGN, and the neutrophil infiltration might be more severe in ANCA-negative pauci-immune-CrGN than in ANCA-positive one.
本研究旨在探讨抗中性粒细胞胞质抗体(ANCA)阴性寡免疫性新月体肾小球肾炎(CrGN)患者肾组织中中性粒细胞浸润的证据,并与 ANCA 阳性患者进行比较。
收集 31 例寡免疫性 CrGN 患者的肾活检标本。12 例患者 ANCA 阴性,19 例患者 ANCA 阳性。采用免疫组织化学染色 2 种标志物 CD15 和髓过氧化物酶(MPO)检测中性粒细胞浸润。
CD15(CD15)和 MPO(MPO+)阳性细胞主要位于细胞性新月体和节段性纤维蛋白样坏死病变的肾小球以及细胞性新月体的肾小球旁区,特别是在破裂的Bowman 囊区。正常肾组织中仅见少量阳性染色。ANCA 阴性组肾小球和肾小球旁区 CD15 细胞数明显高于 ANCA 阳性组(肾小球:2.70±1.61 比 1.38±0.85,P=0.019;肾小球旁区:4.35±4.36 比 1.48±1.67,P=0.047)。ANCA 阴性组肾小球旁区 MPO+细胞数也明显高于 ANCA 阳性组。
肾中性粒细胞浸润可能在 ANCA 阴性寡免疫性 CrGN 中起致病作用,且 ANCA 阴性寡免疫性-CrGN 中的中性粒细胞浸润可能比 ANCA 阳性患者更严重。