Renal Interstitial Infiltration and Tertiary Lymphoid Organ Neogenesis in IgA Nephropathy
Renal Interstitial Infiltration and Tertiary Lymphoid Organ Neogenesis in IgA Nephropathy
复制标题
IgA 肾病的肾间质浸润和三级淋巴器官新生。
DOI：
10.2215/cjn.01150113
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发表时间：
2014-02-07
影响因子：
9.8
通讯作者：
Xu, Gang
中科院分区：
文献类型：
--
作者：
Pei, Guangchang;Zeng, Rui;Xu, Gang
背景和目标
先前的研究已经确定了能够预测伊加肾病（IgAN）肾脏结局的炎症特征;然而，这些发现仍需要验证。本前瞻性研究旨在确定中国IgAN患者队列中肾间质浸润和三级淋巴器官（TLO）新生的特征。
设计、设置、参与者和测量
本研究从2009年6月至2010年6月招募成人IgAN患者。采用免疫组化和免疫荧光法检测肾活检组织中的炎性细胞。评估了间质炎性细胞密度、TLO级别和临床病理特征之间的相关性。在152例合格患者中，72例（47%）在肾活检后30个月通过电话成功随访。根据随访期间血清肌酐水平的进展，12例患者被归类为重度组，60例患者被归类为稳定组。比较两组间质浸润的严重程度和TLO新生的频率。
结果
间质炎性细胞的积聚与IgAN患者肾功能下降、大量蛋白尿和严重的肾小球、间质和动脉病变相关。在37.5%的患者中观察到TLO，其被鉴定为含有机化DC-SIGN（+）、CD 4（+）、CD 8（+）和CD 20（+）细胞的结节性炎性浸润。高级别TLO患者表现出高比例的系膜细胞增生和新月体以及严重的间质和动脉病变。与稳定组患者相比，重度组患者表现出更严重的间质浸润和更高的TLO新生百分比（83.3% vs 33.3%; P=0.001）。
结论
作为活跃的局部炎症反应的贡献者，间质浸润的严重程度和TLO新生的频率与肾小球、间质和动脉病变以及IgAN进展相关。
BACKGROUND AND OBJECTIVES
Previous studies have identified inflammatory features that enable the prediction of renal outcome of IgA nephropathy (IgAN); however, validation of these findings is still needed. This prospective study was performed to determine the characteristics of renal interstitial infiltration and tertiary lymphoid organ (TLO) neogenesis in a cohort of Chinese patients with IgAN.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
Adult patients with IgAN were recruited into this study from June 2009 to June 2010. Inflammatory cells in renal biopsy tissues were detected by immunohistochemistry and immunofluorescence. Correlations between the density of interstitial inflammatory cells, grades of TLOs, and clinicopathologic features were evaluated. Of 152 eligible patients, 72 (47%) were successfully followed-up by telephone at 30 months after renal biopsy. Twelve patients were classified as the severe group and 60 patients were classified as the stable group, according to the progression of serum creatinine levels during the follow-up period. A comparison of the severity of interstitial infiltration and the frequency of TLO neogenesis between the two groups was performed.
RESULTS
The accumulation of interstitial inflammatory cells was correlated with decreased renal function, heavy proteinuria, and severe glomerular, interstitial, and arterial lesions in patients with IgAN. TLOs, identified as nodular inflammatory infiltrates containing organized DC-SIGN(+), CD4(+), CD8(+), and CD20(+) cells, were observed in 37.5% of patients. Patients with high-grade TLOs exhibited a high percentage of mesangial hypercellularity and crescents as well as severe interstitial and arterial lesions. Patients in the severe group exhibited more severe interstitial infiltration and a higher percentage of TLO neogenesis (83.3% versus 33.3%; P=0.001) compared with patients in the stable group.
CONCLUSIONS
As contributors to an active local inflammatory response, the severity of interstitial infiltration and the frequency of TLO neogenesis are correlated with glomerular, interstitial, and arterial lesions as well as IgAN progression.