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目的:探讨系统性红斑狼疮相关血栓性微血管病(SLE-TMA)肾间质血管内皮细胞表型变化及其与血管病变和间质纤维化之间的关系。方法:30例经肾活检明确诊断的SLE-TMA患者,根据血管组织学改变分为急性TMA和慢性TMA,以正常肾组织血管为对照。内皮细胞CD31、血管内皮钙黏蛋白(VE-cadherin)、α平滑肌肌动蛋白(α-SMA)和转化生长因子β(TGF-β)采用间接免疫荧光双重染色定位,免疫组织化学染色和Image-ProPlus 6.0测量上述分子的表达量,以平均光密度表示其表达强度。Aperio图像分析系统测量肾间质纤维化面积。结果:间接免疫荧光双重染色显示正常血管内膜无α-SMA表达,SLE-TMA血管内皮细胞表达α-SMA。与正常对照组相比,急性TMA组血管内皮CD31和VE-cadherin表达降低(P<0.05),α-SMA表达则显著增高(P<0.01);慢性TMA组内皮细胞CD31、VE-cadherin和TGF-β表达强度均显著低于急性TMA组和正常血管组(P<0.01),α-SMA表达更高(P<0.01)。肾间质血管α-SMA平均光密度与肾间质纤维化面积呈显著正相关(r=0.439,P=0.015),而CD31平均光密度与肾间质纤维化呈显著负相关(r=-0.458,P=0.011)。结论:SLE-TMA血管内皮细胞正常标记物表达减少而α-SMA表达增加,表明内皮细胞向成纤维细胞表型转变,且表达量的变化与血管病变进展相关;肾血管内皮细胞CD31表达减少和α-SMA增加与肾间质纤维化相关。
Objective: To investigate the phenotypic changes of renal interstitial vascular endothelial cells in patients with systemic lupus erythematosus-associated thrombotic microangiopathy (SLE-TMA) and its relationship with vascular lesions and interstitial fibrosis. Methods: Thirty patients with SLE-TMA diagnosed by renal biopsy were divided into acute TMA and chronic TMA according to the changes of vascular histology. Normal renal blood vessels were used as control. The expression of CD31, VE-cadherin, α-SMA and TGF-β in endothelial cells were detected by indirect immunofluorescence staining. Immunohistochemical staining and Image- ProPlus 6.0 measures the amount of expression of these molecules, expressing their intensity of expression in terms of average optical density. Aperio image analysis system measures renal interstitial fibrosis area. Results: Indirect immunofluorescence double staining showed that there was no α-SMA expression in normal intima and α-SMA in SLE-TMA vascular endothelial cells. Compared with normal control group, the expression of CD31 and VE-cadherin in vascular endothelial cells of acute TMA group was significantly lower than that of normal control group (P <0.05), while the expression of α-SMA was significantly increased (P <0.01) The expression of α-SMA was significantly lower than that of acute TMA group and normal blood vessel group (P <0.01), and the expression of α-SMA was higher (P <0.01). The mean optical density of renal interstitial α-SMA was positively correlated with the area of renal interstitial fibrosis (r = 0.439, P = 0.015), whereas the mean optical density of CD31 was negatively correlated with renal interstitial fibrosis (r = 0.458, P = 0.011). CONCLUSIONS: The decreased expression of normal markers in SLE-TMA vascular endothelial cells and the increased expression of α-SMA indicate that endothelial cells transform into fibroblast phenotypes and the expression changes correlate with the progression of vascular diseases. The expression of CD31 in renal vascular endothelial cells decreases Increased α-SMA is associated with renal interstitial fibrosis.