甲泼尼龙和环磷酰胺冲击疗法对新月体性肾小球肾炎患者肾脏浸润细胞的影响。

Effects of methylprednisolone and cyclophosphamide pulse therapy on renal infiltrating cells in patients with crescentic glomerulonephritis.

作者信息

Tang Z, Zhou H, Yao X, Hu W, Leishi L

机构信息

Jinling Hospital, School of Medicine, Nanjing University, China.

出版信息

Chin Med J (Engl). 1997 Mar;110(3):206-9.

PMID:9594342

Abstract

OBJECTIVE

To investigate the effects of pulse methylprednisolone (MP) and monthly intravenous cyclophosphamide (CTX) therapy (MP + CTX) on renal infiltrating cells in patients with rapid progressive glomerular nephritis (RPGN).

METHODS

Twelve patients with RPGN (> 50% crescents) were given MP + CTX therapy and received repeated renal biopsies within 4 to 12 weeks after MP + CTX treatment. Seven were diagnosed as type II RPGN, including one case of IgA nephropathy, 2 cases of idiopathic RPGN and 4 cases of lupus nephritis and five were diagnosed as type III RPGN, including 2 cases of idiopathic RPGN and 3 cases of vasculitis. The changes of infiltrating CD4+, CD8+, CD68+ and proliferating cell nuclear antigen-PCNA+ cell levels were determined by four PAP method in glomeruli and interstitium.

RESULTS

In the patients before MP + CTX therapy, there were higher levels of infiltrating CD4+ and CD8+ cells (306 +/- 118 and 223 +/- 98.4Num/mm2) in renal interstitium, CD68+ cells (17.2 +/- 9.95 Num/G) in glomeruli and (1120 +/- 229 Num/mm2) in interstitium, and PCNA+ cells (7.56 +/- 3.57 Num/G) in glomeruli and (17.6 +/- 6.85 Num/mm2) in interstitium as compared with those in the patients after MP + CTX therapy (CD4+/CD8+ cells were 171 +/- 87.5/121 +/- 38.4 Num/mm2, CD68+ cells were 9.04 +/- 4.33 Num/G and 600 +/- 107 Num/mm2, and PCNA+ cells were 2.04 +/- 1.43 Num/G and 9.40 +/- 4.45 Num/mm2). These changes were associated with improving renal dysfunctions (the levels of serum creatinine and proteinuria decreased gradually from 766 +/- 356 to 284 +/- 192 mumol/L and 2.60 +/- 1.46 to 1.29 +/- 0.85 g/day).

CONCLUSIONS

Our data indicate that the renal infiltrating cells may play an important role in renal injury in patients with RPGN. The effects of MP + CTX therapy on improving renal dysfunctions may partially contribute to its amelioration of infiltrating cells in renal tissues. The degrees of CD4+, CD68+, and PCNA+ cells in the kidney may be useful indicators of MP + CTX therapy for RPGN.

摘要

目的

探讨脉冲式甲泼尼龙（MP）和每月静脉注射环磷酰胺（CTX）疗法（MP + CTX）对快速进展性肾小球肾炎（RPGN）患者肾浸润细胞的影响。

方法

12例RPGN（新月体>50%）患者接受MP + CTX治疗，并在MP + CTX治疗后4至12周内接受重复肾活检。7例被诊断为Ⅱ型RPGN，包括1例IgA肾病、2例特发性RPGN和4例狼疮性肾炎；5例被诊断为Ⅲ型RPGN，包括2例特发性RPGN和3例血管炎。采用四抗过氧化物酶法测定肾小球和间质中浸润的CD4 +、CD8 +、CD68 +和增殖细胞核抗原（PCNA）+细胞水平的变化。

结果

与MP + CTX治疗后的患者相比，MP + CTX治疗前患者肾间质中浸润的CD4 +和CD8 +细胞水平较高（分别为306±118和223±98.4个/平方毫米），肾小球中CD68 +细胞水平为（17.2±9.95个/肾小球），间质中为（1120±229个/平方毫米），肾小球中PCNA +细胞水平为（7.56±3.57个/肾小球），间质中为（17.6±6.85个/平方毫米）；MP + CTX治疗后患者上述指标分别为：CD4 + / CD8 +细胞为171±87.5 / 121±38.4个/平方毫米，CD68 +细胞为9.04±4.33个/肾小球和600±107个/平方毫米，PCNA +细胞为2.04±1.43个/肾小球和9.40±4.45个/平方毫米。这些变化与肾功能改善相关（血清肌酐和蛋白尿水平从766±356逐渐降至284±192微摩尔/升，从2.60±1.46降至1.29±0.85克/天）。

结论

我们的数据表明肾浸润细胞可能在RPGN患者的肾损伤中起重要作用。MP + CTX疗法改善肾功能的作用可能部分归因于其对肾组织浸润细胞的改善作用。肾脏中CD4 +（应为CD4+）、CD68 +和PCNA +细胞的程度可能是MP + CTX治疗RPGN的有用指标。（注：原文中‘The degrees of CD4+, CD68+, and PCNA+ cells in the kidney may be useful indicators of MP + CTX therapy for RPGN.’中‘CD4+’疑似多了‘+’，翻译时保留原文表述。）