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目的 探讨原发性肾病综合征 (简称肾病 )患儿的免疫细胞对肾小球固有细胞的直接作用。方法 肾病患儿 2 8例 ,健康体检儿 15例 ,分为未治组、激素组、阴转组及正常对照组。制备外周血单个核细胞条件液 (PBMC -CM ) ,运用肾小球细胞体外培养技术、同位素掺入技术、放射免疫竞争性抑制法 ,检测PBMC -CM刺激后的大鼠肾小球上皮细胞合成层粘连蛋白 (LN)、总胶原、Ⅲ型前胶原、Ⅳ型胶原等基质成分的含量 ;PBMC -CM对大鼠的肾小球系膜细胞3H -TdR掺入指数的影响。结果 4组的LN抑制指数分别为 0 95 ,1 0 2 ,1 0 1,1 0 3 ;3H -羟脯氨酸的掺入指数为 0 93 ,1 2 4,1 2 3 ,1 11;Ⅲ型前胶原的抑制指数为 0 96 ,1 0 0 ,0 99,1 0 1;Ⅳ型胶原抑制指数为 1 0 4,1 0 5 ,1 0 4,1 0 8。未治组患儿PBMC -CM作用后的上皮细胞合成LN、总胶原、Ⅲ型前胶原的指数与其他 3组的差异有显著性 (P <0 0 5 )。 4组的PBMC -CM作用后的大鼠系膜细胞的3H -TdR掺入指数分别为 1 2 1,1 5 3 ,1 5 0 ,1 10 ,4组指数之间差异无显著性 (P >0 0 5 )。结论 肾病患儿的免疫细胞产物具有影响上皮细胞合成部分细胞外基质的活性 ,此活性可被整体使用皮质激素纠正。
Objective To investigate the direct effect of immune cells in glomeruli on children with primary nephrotic syndrome (nephrotic syndrome). Methods 28 cases of children with nephropathy and 15 cases of healthy children were divided into two groups: control group, hormone group, yinzhuan group and normal control group. Peripheral blood mononuclear cells conditioned medium (PBMC-CM) was prepared. The glomerular epithelial cells were stimulated by PBMC-CM by using glomerular cell culture in vitro, isotope incorporation and radioimmunoassay. Laminin (LN), total collagen, procollagen type Ⅲ, type Ⅳ collagen and other matrix components; PBMC-CM on rat mesangial cells 3H-TdR incorporation index. Results The LN inhibition index of the four groups were 0 95, 102 and 110 1 0 3, respectively. The incorporation index of 3H - hydroxyproline was 0 93, 1 24, 1 23, 1 11 The inhibition index of procollagen was 0 96, 1 0 0, 0 99 and 1 0 1, and the inhibition index of type Ⅳ collagen was 1 0 4, 1 0 5, 1 0 4, 1 0 8. The LN, total collagen and type Ⅲ procollagen index of epithelial cells after PBMC-CM treatment in the untreated group were significantly different from the other three groups (P <0.05). 3H-TdR incorporation index of rat mesangial cells in 4 groups after PBMC-CM treatment was 1 2 1, 5 1, 1 5 0, 1 10 respectively, there was no significant difference between the 4 groups (P> 0 0 5). Conclusions Immune cell products in children with nephropathy have an effect on the extracellular matrix of the epithelial cells’ synthesis and this activity can be corrected by the overall use of corticosteroids.