Sobh M A, Moustafa F E, Sally S M, Deelder A M, Ghoniem M A
Urology and Nephrology Center, University of Mansoura, Egypt.
Nephrol Dial Transplant. 1988;3(4):392-8. doi: 10.1093/oxfordjournals.ndt.a091686.
In this work 42 patients with active Schistosoma mansoni infection and renal involvement were examined. Of these, 16 had asymptomatic proteinuria (group I) and 26 had the nephrotic syndrome (group II). Fifteen nonschistosomal patients with idiopathic nephrotic syndrome were included as control cases (group III). Renal biopsy specimens were obtained from all patients and controls. These were examined by light microscopy (LM), by direct immunofluorescence microscopy using antisera against human IgG, IgM, IgA, C3, C4, C1q, and fibrinogen, and by indirect immunofluorescence microscopy using monoclonal antibodies directed against the circulating schistosome antigens, circulating anodic antigen (CCA) and circulating cathodic antigen (CCA). Schistosomal-specific deposits were seen in the renal glomeruli in 24 of the 42 schistosomal patients but in none of the 15 control patients. Although schistosomal-specific deposits were seen in seven of the 16 patients presenting with asymptomatic proteinuria, no morphological changes could be seen by LM. On the other hand, schistosomal-specific deposits could be seen in the kidneys of 17 of the 26 patients presenting with the nephrotic syndrome. All but one specimen showed morphological changes when examined by LM. These were consistent with mesangioproliferative glomerulonephritis in seven, focal segmental glomerulosclerosis in five, mesangiocapillary glomerulonephritis in two, membranous glomerulonephritis in one, and focal segmental hyalinosis in one patient. The present study clearly suggests that (a) schistosomal-specific nephropathy does exist in human settings, (b) it is an immune complex disease, and (c) CAA and CCA are major responsible antigens.
在这项研究中，对42例患有曼氏血吸虫活动性感染并伴有肾脏受累的患者进行了检查。其中，16例有无症状蛋白尿（第一组），26例患有肾病综合征（第二组）。纳入15例非血吸虫性特发性肾病综合征患者作为对照病例（第三组）。所有患者及对照均获取了肾活检标本。这些标本通过光学显微镜（LM）、使用抗人IgG、IgM、IgA、C3、C4、C1q和纤维蛋白原的抗血清进行直接免疫荧光显微镜检查，以及使用针对循环血吸虫抗原、循环阳极抗原（CCA）和循环阴极抗原（CCA）的单克隆抗体进行间接免疫荧光显微镜检查。42例血吸虫病患者中有24例在肾小球中发现了血吸虫特异性沉积物，而15例对照患者中均未发现。虽然在16例无症状蛋白尿患者中有7例发现了血吸虫特异性沉积物，但光学显微镜下未见形态学改变。另一方面，26例肾病综合征患者中有17例在肾脏中发现了血吸虫特异性沉积物。除1例标本外，其余所有标本经光学显微镜检查均显示形态学改变。其中7例符合系膜增生性肾小球肾炎，5例符合局灶节段性肾小球硬化，2例符合系膜毛细血管性肾小球肾炎，1例符合膜性肾小球肾炎，1例符合局灶节段性玻璃样变。本研究清楚地表明：（a）在人类环境中确实存在血吸虫特异性肾病；（b）它是一种免疫复合物疾病；（c）CAA和CCA是主要的致病抗原。
