National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, PR China.
Int Immunopharmacol. 2021 Oct;99:107877. doi: 10.1016/j.intimp.2021.107877. Epub 2021 Jul 1.
Inflammatory cell infiltration is a pathological change commonly seen in renal biopsies from patients with lupus nephritis(LN), but its clinicalcorrelationwith clinical parameters and prognosis is unclear.
Included in this retrospective study were 197 patients with ISN/ RPS Class III-V LN, in whom renal biopsy was performed to analyze the histological pattern. Tubulointerstitial infiltrates were quantitated by standard histochemical staining. Clinical and histologic variables were evaluated using a Cox proportional hazards model. End-stagerenaldisease(ESRD) progression was defined as a two-fold increase in serum creatinine (SCr) after biopsy, GFR decreased over 40%, initiation of dialysis, transplantation, or death.
Of the 197 patients, 166 patients (84.3%) had proliferative LN. The number of tubulointerstitial infiltrates was the lowest in LN patients with ISN/RPS class V, and the number of CD68+ macrophages was the highest in all ISN/RPS classes of LN. In addition, the number of CD8+T cell infiltrates was positively correlated the SLEDAI sore, SCr level, proteinuria, the ratio of glomerulosclerosis and the degree of tubulointerstitial inflammation, interstitial fibrosis and tubular atrophy, activity and chronicity indices, and negatively correlated with C3 level at presentation. Multivariate survival analysis showed that tubulointerstitial CD8 + T cells > 130/mm was associated with ESRD progression (HR 1.007; 95% CI 1.003 to 1.011; p < 0.001).
Tubulointerstitial CD8+T cells correlate with clinicohistologic impairment in LN. Tubulointerstitial CD8+T cells > 130/mm is independently associated with an unfavorable long-term kidney outcome.
炎症细胞浸润是狼疮肾炎（LN）患者肾活检的常见病理改变，但与临床参数和预后的临床相关性尚不清楚。
本回顾性研究纳入了 197 例 ISN/RPS Ⅲ-Ⅴ级 LN 患者，对其进行肾活检以分析组织学模式。采用标准组织化学染色定量肾小管间质浸润。使用 Cox 比例风险模型评估临床和组织学变量。终末期肾脏疾病（ESRD）进展定义为活检后血清肌酐（SCr）增加两倍、GFR 下降超过 40%、开始透析、移植或死亡。
在 197 例患者中，166 例（84.3%）为增生性 LN。ISN/RPS Ⅴ级 LN 患者的肾小管间质浸润数量最低，所有 ISN/RPS 级 LN 患者的 CD68+巨噬细胞数量最高。此外，CD8+T 细胞浸润数量与 SLEDAI 评分、SCr 水平、蛋白尿、肾小球硬化率、肾小管间质炎症、间质纤维化和肾小管萎缩程度、活动指数和慢性指数呈正相关，与就诊时 C3 水平呈负相关。多变量生存分析显示，肾小管间质 CD8+T 细胞>130/mm 与 ESRD 进展相关（HR 1.007；95%CI 1.003 至 1.011；p<0.001）。
肾小管间质 CD8+T 细胞与 LN 的临床组织学损害相关。肾小管间质 CD8+T 细胞>130/mm 与不利的长期肾脏结局独立相关。
