Renal immunofluorescence and the prediction of renal outcome in patients with proliferative lupus nephritis
Renal immunofluorescence and the prediction of renal outcome in patients with proliferative lupus nephritis
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增殖性狼疮肾炎患者肾脏免疫荧光检测及肾脏结局预测
DOI：
10.1177/096120330000900705
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发表时间：
2000
期刊：
影响因子：
2.6
通讯作者：
T. Swaak
中科院分区：
文献类型：
--
作者：
H. Nossent;J. Berden;T. Swaak
增生性狼疮性肾炎(PLN)患者发生终末期肾功能衰竭的风险在很大程度上取决于光镜(LM)所确定的炎症过程的严重性和可逆性。由于免疫复合体在肾内的形成被认为是引发这种炎症的原因，我们研究了肾脏免疫荧光显微镜(IFM)除了能提供LM的结果外，是否还能提供临床或预后信息。从69例增生期LN(WHO III/IV级)SLE患者的记录中提取肾活检时和平均随访46个月的临床资料。活检标本用光镜进行AI和CI分析，而IFM则在冰冻切片上用抗Ig G、1gm、Ig A、C3、C1q和纤维蛋白的抗血清进行。根据定位(肾小球、肾小管或血管)和荧光强度(从0到3分)记录IFM表现。然后将IFM结果与临床和LM结果相关联，并通过生存分析研究其预后价值。99%的患者存在肾小球免疫沉积，38%的患者存在管状沉积，17%的患者存在血管沉积。67%的活检组织和93%的C3和74%的C1q沉积物呈全屋模式(所有三种Ig类型)。AI和CI的中位数分别为6(1-18)和3(0-10)，除IgA沉积与CI呈负相关外，免疫沉积的数量或类型与AI或CI无其他相关性。IgM沉积与高水平的抗dsDNA相关，而IgG沉积与高ESR和血清肌酐水平相关。IFM评分与活检时的类固醇剂量无关，肾小球、肾小管或整个肾脏的免疫沉积类型对肾脏存活率均无预后价值。肾免疫荧光不能反映PLN患者的光镜表现，也不能提供PLN患者的预后信息。
The risk for endstage renal failure in patients with proliferative lupus nephritis (PLN) depends largely on the severity and reversibility of the inflammatory process as determined by light microscopy (LM). As the intrarenal formation of immune complexes is thought to initiate this inflammation, we studied whether renal immunofluorescence microscopy (IFM) provides clinical or prognostic information in addition to LM findings. Clinical data at the time of renal biopsy and during a mean follow-up of 46 months were extracted from the records of 69 SLE patients with proliferative LN (WHO class III/IV). Biopsy specimens were analyzed by LM for AI and CI, while IFM was performed on cryostat sections with the use of antisera against IgG, 1gM, IgA, C3, C1q and fibrin. IFM findings were recorded in terms of the localization (glomerular, tubular or vascular) and intensity of fluorescence (score from zero to three). IFM findings were then related to clinical and LM findings and its prognostic value studied by survival analysis. Glomerular immune deposits were present in 99% of patients, tubular deposits in 38% and vascular deposits in 17%. A ‘full-house’ pattern (all three Ig classes) was found in 67% of biopsies and C3 and C1q deposits in 93% and 74% respectively. Median scores for AI and CI were 6 (1–18) and 3 (0–10); aside from a negative correlation between IgA deposits and CI, we found no other correlation between the amount or type of immune deposits and AI or CI. IgM deposits were associated with high serumlevels of anti-dsDNA, while IgG deposits correlated with high ESR and serumcreatinin levels. IFM scores were not related to steroiddose at the time of biopsy and neither type of glomerular, tubular or overall renal immunedeposits had prognostic value for renal survival. Renal immunofluorescence does not reflect light microscopy findings in patients with PLN and does not contribute prognostic information in patients with PLN.
DOI：
10.1073/pnas.97.3.1184
发表时间：
2000-02-01
影响因子：
11.1
作者：
Boes, M;Schmidt, T;Chen, JZ
通讯作者：
Chen, JZ