关键词: 关键词：肥大细胞, 胰蛋白酶, 纤维化, 抗肾小球基膜肾炎

Abstract:

ABSTRUCT Objective: To investigated the roles of renal mast cell infiltrations in patients with Anti-GBM nephritis. Methodology: Thirty eight patients diagnosed as anti-GBM nephritis in our institute from 2001 to 2010 were enrolled in this study. Renal biopsies were performed in all patients. The clinical and pathological data were collected. The tryptase was stained by immunohistochemistry for detecting mast cells in renal tissue. According to the infiltrating renal mast cell count, the patients were divided into group 1 (mast cell<50/mm2, n=18) and group 2 (mast cell≥50/mm2,  n=20,). The clinical, laboratory and pathological indices were compared between the two groups. Correlation between mast cells and patients’ clinical and pathological indices was investigated. Results: In patients of group 2, they had longer disease course, older in age, higher percents of gross hematuria, oliguria/anuria, a more serious degree of anemia and less urine protein and microscope hematuria, as well as a higher level of anti-GBM antibodies. Moreover, the patients in group 2 were more serious in renal dysfunctions, which expressed as higher levels of serum creatinine (Scr, 791±324 vs 412±241 mol/L, P<0.001) and urine retinol-binding protein (RBP, 29.8±13.9 vs 15.7±11.5mg/dl, P = 0.005), but lower urinary osmotic pressure. In pathology, the patients in group2 were observed to have a higher percentage of glomerular sclerosis and Bowman's wall fracture and more serious degree of fibrosis although no significant differences were observed. They also had a higher percentage of fibrous/fibrocellular crescents (66.7±21.9 vs 47.0±33.6％, P = 0.037)  while a lower cellular crescents in group2. There were more inflammatory cells including CD4, CD8 and CD68 positive cells infiltrated in the interstitium of group2. Among these inflammatory cells, the infiltration of CD8 positive T cell  (268/mm2 vs 180/mm2, p=0.045) and CD68 positive T cell（792 vs 534/mm2，p=0.017）had a significant difference between the two groups. Furthermore, renal MCs correlated significantly with the total number of crescents and the tubular interstitial inflammatory cells, including macrophages and T lymphocytes.  Conclusion: Renal mast cell infiltrations were associated with chronic lesion in anti-GBM nephritis and contributed to loss of renal function with pathological changes of both glomerular and tubular-interstitial damage and inflammatory.