| Objective:To investigate the clinical and pathological features of renal interstitial inflammatory cell infiltration in IgAN,and to understand the expression of CD3,CD20and CD68 in IgAN renal interstitium and its relationship with clinical and pathological features.Method:1.A total of 355 patients diagnosed with primary IgAN who underwent renal biopsy from November 2016 to March 2022 were collected from Anhui Provincial Hospital South District,grouped according to the area of inflammatory cell infiltration in the renal interstitium under light microscopy;mild group:inflammatory infiltration area<25%;severe group:inflammatory infiltration area>25%.The clinical and pathological characteristics of the patients with different inflammatory cell infiltration areas in the two groups were analyzed.2.Forty-two patients diagnosed with primary IgAN from February 2021 to December2021 were selected as the experimental group,and 5 normal renal tissues due to renal trauma or renal tumor resection in the Department of Urology of our hospital were selected as the control group.Immunohistochemistry was used to detect the expression of CD3,CD20 and CD68 in renal tissues of the 47 patients.The positive expression of CD3,CD20 and CD68 in renal interstitial tissue was analyzed in relation to the progression of IgAN.Spearman correlation analysis was used to analyze the correlation between the expression of inflammatory mediators and clinical and pathological features,and to explore the significance of the expression of inflammatory mediators in the renal interstitium of IgAN.Results:1.A total of 355 IgAN patients were enrolled,including 174 males and 181females.The median age was 34 years old,and the median 24h urinary protein was1385.0mg.The proportion of M1,E1,S1,T1+T2 and C1+C2 in Oxford score was 97.7%,46.8%,48.5%,28.5%and 61.7%,respectively.2.Compared with the mild inflammatory cell infiltration group,the levels of blood pressure,total triglyceride,24h urinary protein,Scr,UA and BUN in the severe IgAN group were higher,the proportion of patients with CKD stage 3 and above,Lee’sⅣ-Ⅴgrade was higher,and the proportion of patients with higher S,T and C scores was increased(P<0.05).The e GFR and Hb levels were lower,the difference was statistically significant(P<0.05),and there was no significant difference in other clinical indicators between the two groups.3.In 355 IgAN cases,Spearman correlation analysis showed that the infiltration area of inflammatory cells was positively correlated with Lee’s pathological grade,E,S,T,C,total number of sclerosing glomerulus/glomerulus,total number of crescent/glomerulus,renal interstitial fibrosis,and renal tubular atrophy area,24h urinary protein,Scr(r1=0.658,r2=0.125,respectively;r3=0.170,r4=0.667,r5=0.206,r6=0.482,r7=0.290,r8=0.589,r9=0.654,r10=0.135,r11=0.563 and all P<0.05).And negatively correlated with e GFR(r=-0.580,P<0.05).4.There were 22 males and 20 females in 42 patients with primary IgAN,aged from 19to 65 years old,with a median of 40.5 years old.The median of 24h urinary protein was1395.5mg,and the interquartile range was 952.8 mg-404.0 mg.S1 accounted for 83.3%,T1+T2 accounted for 35.7%,and C1+C2 accounted for 71.4%.There was no significant difference in baseline characteristics between 42 patients and 355 IgAN patients(P>0.05).5.There were 42 patients in IgAN group and 5 patients in control group.Compared with the control group(respectively 0.020 VS 0.003,0.031 VS 0.003,0.018 VS 0.005),CD3,CD20 and CD68 were significantly expressed in IgAN group,and the difference was statistically significant(P<0.05).6.There were 27 patients in the T0 group,10 patients in the T1 group and 5 patients in the T2 group.There were significant differences in the expression of CD3,CD20 and CD68 among different renal interstitial fibrosis groups(P<0.05).The expression levels of CD3,CD20 and CD68 in T1 group and T2 group were significantly higher than those in T0 group(P<0.05).There was no significant difference between T1 and T2 groups,but the expression of CD3,CD20 and CD68 in T2 group was higher than that in T1 group.7.There were 5 cases of mild interstitial injury,22 cases of moderate interstitial injury and 15 cases of severe interstitial injury according to the interstitial injury score.The expression levels of CD3,CD20 and CD68 were significantly different in different interstitial injury groups(P<0.05).The expression levels of CD3,CD20 and CD68 in the mild interstitial injury group were significantly lower than those in the severe interstitial injury group(P<0.05).The expression levels of CD3,CD20 and CD68 in the moderate interstitial injury group were significantly lower than those in the severe interstitial injury group.There was no significant difference between the mild interstitial injury group and the moderate interstitial injury group,but the expression of CD3,CD20 and CD68 in the moderate interstitial injury group was higher than that in the mild interstitial injury group(P<0.05).8.According to Lee’s classification,there were 24 patients with LeeⅠ-Ⅲand 18 patients with LeeⅣ-Ⅴ.The expression of CD3,CD20 and CD68 in LeeⅠ-Ⅲwas significantly lower than that in LeeⅣ-Ⅴ,and the difference was statistically significant(P<0.05).9.According to e GFR≥60 m L/min/1.73m~2,e GFR30-59 m L/min/1.73m~2,e GFR<30m L/min/1.73m~2,the expression levels of CD3,CD20 and CD68 in different e GFR groups were significantly different(P<0.05).The expression levels of CD3,CD20 and CD68 in the e GFR<30 m L/min/1.73m~2 group were significantly higher than those in the e GFR≥60 m L/min/1.73m~2 group(P<0.05).There was no significant difference between the other groups,but with the decrease of glomerular filtration rate.The expression of CD3,CD20 and CD68 increased gradually.10.According to different urinary protein quantitative grouping,there was no statistically significant difference in the expression of CD3,CD20 and CD68 among different groups.11.In IgAN,using Spearman correlation analysis,CD3 was positively correlated with Lee’s pathological grade,CKD stage,E,T,C,interstitial damage score,renal interstitial fibrosis,inflammatory infiltration area,tubular atrophy area,crescentic body number,24h urinary protein,Scr,UA,BUN(r1=0.645,r2=0.503,r3=0.532,r4=0.607,r5=0.470,r6=0.615,r7=0.399,r8=0.571,r9=0.579,r10=0.415,r11=0.348,r12=0.597,r13=0.452,r14=0.416;and all P<0.05).It was negatively correlated with serum Ig G,ALB and e GFR(r1=-0.349,r2=-0.357,r3=-0.589,all P<0.05),but there was no obvious correlation with other indicators.CD20 was positively correlated with Lee’s pathological grade,CKD stage,E,T,C,interstitial damage score,renal interstitial fibrosis,inflammatory infiltration area,renal tubular atrophy area,24h urinary protein,Scr,UA and BUN(r1=0.661,r2=0.423,r3=0.413,r4=0.579,r5=0.447,r6=0.709,r7=0.691,r8=0.529,r9=0.536,r10=0.346,r11=0.605,r12=0.346,r13=0.335,all P<0.05),and negatively correlated with e GFR(r=-0.539,P<0.001),but there was no obvious correlation with other indicators.CD68 was positively correlated with Lee’s pathological grade,CKD stage,T,interstitial damage score,renal interstitial fibrosis,inflammatory infiltration area,renal tubular atrophy area,24h urinary protein,Scr,UA and BUN(r1=0.552,r2=0.410,r3=0.569,r4=0.644,respectively;r5=0.506,r6=0.578,r7=0.630,r8=0.324,r9=0.486,r10=0.378,r11=0.397,all P<0.05),and negatively correlated with e GFR(r=-0.516,P<0.001),but there was no obvious correlation with other indicators.Conclusion:1.IgAN patients with severe interstitial inflammatory cell infiltration had more severe clinicopathological process.2.There is a cell-mediated immune response in the renal interstitium of IgAN.3.The positive expression of CD3,CD20 and CD68 in renal interstitium increases with the aggravation of pathological grade,and correlated with renal fibrosis,which plays an important role in the progression of renal lesions.4.The expression of CD3,CD20 and CD68 in renal tissue of IgAN patients is related to renal function,which may become aeffective and reliable predictor of renal progress. |
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