Immunohistochemical detection of intravascular platelet microthrombi in patients with lupus nephritis and anti-phospholipid antibodies
Immunohistochemical detection of intravascular platelet microthrombi in patients with lupus nephritis and anti-phospholipid antibodies
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DOI：
10.1093/rheumatology/kep152
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发表时间：
2009-08-01
期刊：
影响因子：
5.5
通讯作者：
Pablos, Jose L.
中科院分区：
文献类型：
--
作者：
Galindo, Maria;Gonzalo, Elena;Pablos, Jose L.
目标.评估血小板免疫组织化学（IHC）标记物的使用是否提高了SLE肾炎和aPL中微血栓形成的组织学检测方法的灵敏度，并分析微血栓形成在这种情况下的临床病理学相关性。采用抗血小板糖蛋白CD41和CD61抗体，对65例SLE患者（其中36例aPL阳性）肾活检标本进行免疫组化研究。记录肾活检时和活检后平均7.5年随访期间的临床数据，并结合组织学或IHC数据进行分析。在33%的SLE肾活检中发现了先前定义为APS肾病的组织学病变，并且与阳性APL无关。在43%的组织中检测到血管内CD61（+）血小板沉积的微血栓，并与阳性aPL显著相关，但与组织学APS肾病、肾炎表现或肾脏结局无关。组织学APS病变而非CD61（+）微血栓与肾炎表现年龄较大、既往心血管危险因素和肾功能预后较差相关。免疫检测血管内CD61（+）血小板聚集比组织学评价更敏感，以检测急性微血栓形成，并提供了更好的相关性与aPL的SLE患者。相反，与APS肾病一致的组织学病变与APL无关，但与心血管风险因素和更差的肾脏结局相关。
Objectives. To evaluate whether the use of platelet immunohistochemistry (IHC) markers improves the sensitivity of histological methods to detect microthrombosis in SLE nephritis and aPLs and to analyse the clinicopathological correlations of microthrombosis in this setting.Methods. Kidney biopsy specimens from 65 patients with SLE, including 36 with positive aPLs, were studied by IHC using antibodies against platelet glycoproteins CD41 and CD61. Clinical data at the time of kidney biopsy and during a mean follow-up of 7.5 years after biopsy were recorded and analysed with regard to histological or IHC data.Results. Histological lesions previously defined as APS nephropathy were found in 33% of the SLE kidney biopsies and were not associated with positive aPLs. Microthrombi detected as intravascular CD61(+) platelet deposits were present in 43% of the tissues and were significantly associated with positive aPLs, but not with histological APS nephropathy, nephritis manifestations nor with renal outcome. Histological APS lesions but not CD61(+) microthrombi correlated with an older age at nephritis presentation, previous cardiovascular risk factors and worse renal outcome.Conclusions. Immunodetection of intravascular CD61(+) platelet aggregates is more sensitive than histological evaluation to detect acute microthrombosis and provides a better correlation with aPLs in SLE patients. In contrast, histological lesions consistent with APS nephropathy were not associated with aPLs but with cardiovascular risk factors and worse renal outcome.