Immunohistological study in sixteen children with acute tubulointerstitial nephritis.
Immunohistological study in sixteen children with acute tubulointerstitial nephritis.
复制标题
16 例急性肾小管间质性肾炎患儿的免疫组织学研究。
作者：
Y. Kobayashi;M. Honda;N. Yoshikawa;H. Ito
十六个孩子（7名男孩和9名女孩，年龄1.9 - 14.8岁）诊断为急性肾小管间质性肾炎[ATIN：4例药物性，6例感染，2例肾小管间质性肾炎和葡萄膜炎综合征（TINU），4未分类]对6例无症状镜下血尿的儿童进行了研究，以表征疾病临床表现中涉及的间质单核细胞的性质。作为对照研究肾活检组织学变化最小。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CD 3、CD 4和CD 8 T淋巴细胞的数量分别显著大于微小病变肾[CD 3 T细胞;中位数94（范围3.2-330）/mm 2间质面积vs.中位数7.8（范围1.1-23），p = 0.003，CD 4 T细胞; 11（范围0.5-78）对比1.5（范围0-7.7），p = 0.018，CD 8 T细胞; 22（范围1.0-150）对比2.9（范围0-14），p = 0.047]。此外，发现CD 3和CD 4 T细胞之间呈正相关。另一方面，关于CD 3和CD 8 T细胞之间的关系，在感染诱导组中有3例CD 8/CD 3极低，但其他3组不包括CD 8/CD 3极低的病例。虽然间质单核细胞/巨噬细胞的数量小于T淋巴细胞，但T淋巴细胞和单核细胞/巨噬细胞之间呈正相关（CD 3 T细胞与单核细胞/巨噬细胞; r = 0.53，p = 0.039）。从发病到肾活检的持续时间与单核细胞受累无关。这些结果表明，细胞免疫，主要是T淋巴细胞，可能在儿童ATIN的发病机制中发挥作用。
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.