Correlation Between Expression Of CD3,CD20 And CD68 In Renal Interstitium Of IgA Nephropathy And Disease Severity

Objective:To identify the positive expression of renal interstitial CD3,CD20 and CD68in IgA nephropathy（IgAN）with different pathological grades and different degrees of fibrosis,and the relationship between them and clinical indexes to comprehend the degree of renal lesions and evaluate the prognosis of patients,so it is possible to predict the prognostic information of IgAN.Methods:From December 2016 to December 2019,40 patients served as the experimental group diagnosed with primary IgAN by means of biopsy of Nephrology Department,Affiliated Hospital of Yan’an University and Patients who had been treated with glucocorticoid or immunosuppressive agents before hospitalization and renal perforation were excluded,and lupus nephritis,henoch-schonlein purpura nephritis,liver-related kidney damage and renal damage in rheumatoid arthritis and other secondary IgA nephropathy.In addition,clinicalpathologic data is incomplete,and others were not in our line of patients with renal biopsy and so on.5 Patients with normal renal tissue who underwent renal tumor or renal trauma surgery in the Urinary Surgery of our hospital at the same time were selected as the control group.General data such as gender,age and disease courses of each patient were recorded as well as 24-hour urine protein quantification and serum creatinine were noted and glomerular filtration rate and other clinical data were estimated as well.Moreover,Immunohistochemistry was used to measure the expression of differentiated antigen cluster CD（CD3,CD20,CD68）with specific marker on the membrane surface of various cells in the renal interstitium,and the positive staining area was recorded.SPSS22.0 software was used for data processing to analyze the relationship between the positive expression level of renal interstitial CD molecule series and clinical indicators as well as pathology,and the correlation between the positive expression level and IgAN severity so as to explore the significance of interstitial CD3、CD20、CD68 expression in IgAN.Results:1.A total of 40 IgAN patients in the case group were collected including 21 males and 19females,with an average age of 42.03±15.54 years old.In the control group,there were5 normal renal tissues including 3 males and 2 females,with an average age of 51.00±7.38 years old;2.CD3,CD20 and CD68 were significantly expressed in the renal interstitial of kidney tissues in the IgAN group,but this was not or occasionally a small amount in the normal control group.The expressions of CD3,CD20 and CD68 were significantly increased in the IgAN group compared with the normal control group,and the differences were with statistically significant.（P<0.05）;3.A group of patients with IgAN pathologically Lee classification result:0 cases of IgAN-Ⅰlevel（0%）;6 cases of IgAN-Ⅱlevel（15%）;18 cases of IgAN-levelⅢ（45%）;12 cases of IgAN-Ⅳlevel（30%）;4 cases of IgAN-Ⅴlevel（10%）;and the expressions of CD3,CD20 and CD68 in Lee’s grading were gradually enhanced with the increase of grading degree.Compared with CD3,CD20,CD68 expression in IgAN-Ⅱ-Ⅲlevel,these expressions in IgAN-Ⅳ-Ⅴlevel increased significantly,and the differences were statistically significant（P<0.05）;4.The degree of renal tubular fibrosis in the IgAN group as classified by Oxford was T0in 17 patients（42.5%）.T1 15 cases（37.5%）;T2 8 cases（20%）;CD3,CD20 and CD68were compared among the three groups.The expressions of CD3,CD20 and CD68 in renal interstitium increased with the increase of interstitial fibrosis,and the comparison among these groups was statistically significant（P<0.05）;5.The expressions of CD3,CD20 and CD68 in renal interstitium were all increased in the group with increased serum creatinine compared with the normal group,and the differences were statistically significant（P<0.05）.The expressions of CD3,CD20 and CD68 in renal interstitial tissues were increased in the eGFR<90ml·min^-1·（1.73m²）^-1group compared with the eGFR≥90ml·min^-1·（1.73m²）^-11 group,and the differences were statistically significant（P<0.05）;6.Single-factor correlation analysis:the expressions of CD3,CD20 and CD68 in renal interstitium were positively correlated with 24-hour urinary protein quantification and Scr,and were negatively correlated with eGFR,and the differences were statistically significant（P<0.05）.Conclusion:1.The expressions of CD3,CD20 and CD68 in IgAN renal interstitium may be involved in the occurrence and development of IgAN through the mediated immune inflammatory response mechanism.2.Positive expressions of CD3,CD20 and CD68 in IgAN renal interstitium can reflect the severity of renal pathological damage and interstitial fibrosis.3.The positive degree of the expressions of CD3,CD20 and CD68 in IgAN renal interstitium and the related clinical indicators may have a certain correlation,and the immune inflammation reaction that its positive inflammatory cells participated in may played a vital role in the formation of proteinuria and the process of renal function deterioration and this reaction may be involved in the process of renal fibrosis,and then become a predictor of renal progression.