Kobayashi Y, Honda M, Yoshikawa N, Ito H
Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan.
Clin Nephrol. 1998 Jul;50(1):14-20.
Sixteen children (7 boys and 9 girls, aged 1.9 to 14.8 years) diagnosed with acute tubulointerstitial nephritis [ATIN: 4 drug-induced, 6 infection, 2 tubulointerstitial nephritis and uveitis syndrome (TINU), and 4 unclassified] were studied to characterize the nature of the interstitial mononuclear cells involved in each clinical picture of the disease Six children with asymptomatic microscopic hematuria whose histology was a minimal change in renal biopsy were studied as controls. The enzyme immunoassay was carried out using the biopsy specimen obtained from 4 to 42 days after the onset of illness. In ATIN, the number of renal interstitial infiltrating CD3, CD4, and CD8 T lymphocytes, respectively, was significant larger than that in the minimal change kidneys [CD3 T cells; median 94 (range 3.2-330)/mm2 interstitial area vs. median 7.8 (range 1.1-23), p = 0.003, CD4 T cells; 11 (range 0.5-78) vs. 1.5 (range 0-7.7), p = 0.018, CD8 T cells; 22 (range 1.0-150) vs. 2.9 (range 0-14), p = 0.047]. In addition, a positive correlation was found between the CD3 and CD4 T cells. On the other hand, in regard to the relationship between the CD3 and CD8 T cells, CD8/CD3 was extremely low in 3 cases in the infection-induced group, but the other 3 groups included no extremely low CD8/CD3 cases. Although interstitial monocytes/macrophages were smaller than the T lymphocytes in number, a positive correlation was revealed between the T lymphocytes and monocytes/macrophages (CD3 T cells vs. monocytes/macrophages; r = 0.53, p = 0.039). No relationship was found between the duration from the onset of illness to renal biopsy and mononuclear cell involvement. These findings suggest that cellular immunity, mainly T lymphocytes, may play a role in the pathogenesis of ATIN in children.
对16名诊断为急性肾小管间质性肾炎（ATIN：4例药物性、6例感染性、2例肾小管间质性肾炎和葡萄膜炎综合征（TINU）、4例未分类）的儿童（7名男孩和9名女孩，年龄1.9至14.8岁）进行研究，以明确参与该疾病各临床情况的间质单核细胞的性质。将6名组织学显示肾活检为微小病变且有无症状镜下血尿的儿童作为对照。使用发病后4至42天获得的活检标本进行酶免疫测定。在ATIN中，肾间质浸润的CD3、CD4和CD8 T淋巴细胞数量分别显著多于微小病变肾脏[CD3 T细胞；间质面积中位数94（范围3.2 - 330）/mm² 对比中位数7.8（范围1.1 - 23），p = 0.003，CD4 T细胞；11（范围0.5 - 78）对比1.5（范围0 - 7.7），p = 0.018，CD8 T细胞；22（范围1.0 - 150）对比2.9（范围0 - 14），p = 0.047]。此外，发现CD3和CD4 T细胞之间呈正相关。另一方面，关于CD3和CD8 T细胞的关系，感染诱导组中有3例CD8/CD3极低，但其他3组未出现CD8/CD3极低的病例。虽然间质单核细胞/巨噬细胞数量少于T淋巴细胞，但T淋巴细胞与单核细胞/巨噬细胞之间呈正相关（CD3 T细胞对比单核细胞/巨噬细胞；r = 0.53，p = 0.039）。未发现从发病到肾活检的持续时间与单核细胞参与之间的关系。这些发现表明，主要是T淋巴细胞的细胞免疫可能在儿童ATIN的发病机制中起作用。
