CAJ | 학술논문

目的研究狼疮肾炎（ LN）患者肾脏组织中白细胞介素-21（ IL-21）的表达特点，为探讨IL-21在LN中的作用提供重要的临床病理学证据。方法采用免疫组化技术对40例LN患者及5例健康对照组肾脏组织中IL-21的表达水平进行检测，结合临床资料及肾脏病理进行相关分析。结果 IL-21阳性细胞主要在肾小管间质中表达，在肾小球中无表达；LN肾组织中IL-21表达较正常对照组明显增多（ P＜0.05），且病变较严重的Ⅲ型、Ⅳ型LN尤为明显，Ⅲ型＋Ⅳ型与Ⅰ型＋Ⅱ型相比差异有统计学意义（ P＜0.05）；IL-21在肾小管间质的表达水平随LN小管肾间质病变程度的加重而增强（ r＝0.548，P＜0.01）；肾脏组织中IL-21表达与血肌酐、24 h尿蛋白定量、系统性红斑狼疮疾病活动指数、病理活动性指数、病理慢性指数呈正相关（ r＝0.418、0.326、0.450、0.518、0.415，P均＜0.05），与血清补体C3无明显相关性（ P＞0.05）。结论 LN肾组织中IL-21表达增加与肾脏病变程度和病理类型及肾损害密切相关，可作为判断LN活动及严重程度的指标，在LN发病机制中可能起重要作用。
목적연구랑창신염（ LN）환자신장조직중백세포개소-21（ IL-21）적표체특점，위탐토IL-21재LN중적작용제공중요적림상병이학증거。방법채용면역조화기술대40례LN환자급5례건강대조조신장조직중IL-21적표체수평진행검측，결합림상자료급신장병리진행상관분석。결과 IL-21양성세포주요재신소관간질중표체，재신소구중무표체；LN신조직중IL-21표체교정상대조조명현증다（ P＜0.05），차병변교엄중적Ⅲ형、Ⅳ형LN우위명현，Ⅲ형＋Ⅳ형여Ⅰ형＋Ⅱ형상비차이유통계학의의（ P＜0.05）；IL-21재신소관간질적표체수평수LN소관신간질병변정도적가중이증강（ r＝0.548，P＜0.01）；신장조직중IL-21표체여혈기항、24 h뇨단백정량、계통성홍반랑창질병활동지수、병리활동성지수、병리만성지수정정상관（ r＝0.418、0.326、0.450、0.518、0.415，P균＜0.05），여혈청보체C3무명현상관성（ P＞0.05）。결론 LN신조직중IL-21표체증가여신장병변정도화병리류형급신손해밀절상관，가작위판단LN활동급엄중정도적지표，재LN발병궤제중가능기중요작용。
Objective To investigate the role of IL-21 involved in the pathogenesis of SLE , expression pattern of IL-21 in the kidney tissue of patients suffered lupus nephritis ( LN) was examined .Methods Renal tissues of 40 LN patients and 5 healthy people controls was collected and the expression pattern of IL-21 was detected by paraffin-section immunohistochemistry .The correlation of IL-21 with the clinic-pathological parameters and renal pathology was also assessed .Results Naturally,staining for IL-21 was mainly observed in renal interstitium ,but not in the glomerulus.In the tissue of lupus nephritis,the expression of IL-21 was significantly higher(P<0.05)than that in the healthy control ,especially in the type Ⅲ and type Ⅳ LN.There was statistical significance ( P<0.05 ) between type ⅣLN and other non-type Ⅳ LN.The increased percentage of IL-21 in renal interstitium was highly related to the disease severity of tubulointerstitial damage ( r=0.548 ,P<0.01 ) .IL-21 was positively correlated with the level of serum creatinine(Scr),24 hour urinary protein(24 h UP),SLE disease activity index(SLEDAI)points, the scores of activity index(AI)and the score of chronic index(CI)(P<0.05 for each).Otherwise,there was no correlation between IL-21 and level of serum C3(P >0.05).Conclusions Our results demonstrate that IL-21 expression was increased abnormally in renal tissue of LN ,which was associated with the severity of injury and types of renal pathology and clinical index for renal damage .Therefore , IL-21 plays an important role in lupus nephritis pathogenesis .IL-21 would be recognized as a better predictor of LN activity and severity .