Schwartz M M, Roberts J L, Lewis E J
Hum Pathol. 1983 Feb;14(2):158-67. doi: 10.1016/s0046-8177(83)80245-7.
The authors report four cases of systemic lupus erythematosus (SLE) with severe, active glomerulonephritis. Associated with histologic evidence of glomerular inflammation were focal, predominantly mesangial immune reactants. This finding contrasts with reports that massive subendothelial electron-dense deposits are the ultrastructural feature that correlates best with the severity of glomerular inflammation. The patients studied had significantly fewer subendothelial electron-dense deposits than did other patients with SLE with comparable glomerular lesions (8 +/- 3 per cent versus 42 +/- 14 per cent of glomerular capillaries involved, respectively; P less than 0.05). In addition, serologic evidence of disease activity, assessed by measurement of serum levels of C3, C4, circulating immune complexes (cryoglobulins), and serum antinative DNA activity, was either normal or only mildly abnormal. The lack of correlation between the severity of glomerular lesions on the one hand and the paucity of glomerular immune reactants and mild serologic abnormalities on the other may be interpreted as questionable evidence that these cases of glomerulonephritis were mediated by immune complexes. In the light of recent clinical and experimental studies that support a possible role for cell-mediated immunity in the pathogenesis of glomerulonephritis, the authors propose that a role for cell-mediated hypersensitivity be considered.
作者报告了4例患有严重活动性肾小球肾炎的系统性红斑狼疮（SLE）病例。与肾小球炎症的组织学证据相关的是局灶性、主要为系膜免疫反应物。这一发现与大量内皮下电子致密沉积物是与肾小球炎症严重程度最相关的超微结构特征的报道形成对比。所研究的患者内皮下电子致密沉积物明显少于其他患有类似肾小球病变的SLE患者（分别累及8±3%和42±14%的肾小球毛细血管；P<0.05）。此外，通过测量血清C3、C4水平、循环免疫复合物（冷球蛋白）和血清抗天然DNA活性评估的疾病活动的血清学证据要么正常，要么仅轻度异常。一方面肾小球病变的严重程度与另一方面肾小球免疫反应物的缺乏和轻度血清学异常之间缺乏相关性，这可能被解释为这些肾小球肾炎病例由免疫复合物介导的证据存疑。鉴于最近支持细胞介导的免疫在肾小球肾炎发病机制中可能起作用的临床和实验研究，作者建议考虑细胞介导的超敏反应的作用。
