目的:观察肥胖相关性肾病(obesity related glomerulopathy,ORG)患者肾组织肥大细胞数量、分布特点及其与病情的关系,探讨肥大细胞与ORG肾组织损伤及病情进展之间的关系。方法:选取经肾活检确诊的ORG39例,应用免疫组化及双重免疫荧光法检测肾组织中肥大细胞(类胰蛋白酶)和巨噬细胞(CD68)分布情况,分析两者与临床病理之间的关系。结果:ORG患者肾组织中肥大细胞数显著高于对照组(P<0.01),其主要分布在肾间质,以萎缩的肾小管和间质纤维化处更多见,并可见肾小管炎;肾小球内未见肥大细胞浸润,但球囊周围可见肥大细胞浸润;小血管周围也可见肥大细胞浸润。肾间质肥大细胞数与体质量指数(body mass index,BMI)(r=0.364,P<0.05)、收缩压(r=0.459,P<0.01)、舒张压(r=0.347,P<0.05)、尿N-乙酰-β-D-葡萄糖苷酶(NAG)(r=0.324,P<0.05)、血清肌酐(SCr)水平(r=0.637,P<0.01)、肾小球球性硬化(r=0.409,P<0.01)、肾小球节段硬化(r=0.457,P<0.01)、肾小管萎缩(r=0.470,P<0.01)和肾间质纤维化(r=0.669,P<0.01)指标间成正相关,与采用MDRD公式计算的肾小球滤过率(eGFR)水平呈负相关(r=-0.559,P<0.01)。ORG患者肾组织巨噬细胞数也显著高于对照组,且主要分布在有较多炎性细胞浸润的肾间质中,肾小球内也有少量浸润。巨噬细胞数量与间质炎细胞数量呈正相关(r=0.476,P<0.01)。双重免疫荧光染色提示巨噬细胞与肥大细胞在分布上有一定的一致性。多元回归分析显示肾间质肥大细胞浸润程度是影响eGFR水平的独立因素。结论:本研究证实ORG患者肾间质肥大细胞数量增多,并主要分布在肾小管周围、间质纤维化处和肾小球球囊周围,其数量与BMI、血压、肾小管损伤及肾功能进展之间存在显著的相关性,表明肥大细胞参与了ORG的发生和发展过程。 OBJECTIVE: To observe the relationship between the number and distribution of mast cells and the condition in the kidney of obesity-related glomerulopathy (ORG) patients and to explore the relationship between mast cells and the injury of the kidney and the progression of the disease. Methods: 39 cases of ORG diagnosed by renal biopsy were selected. The distribution of mast cells (tryptase) and macrophages (CD68) in renal tissues was detected by immunohistochemistry and double immunofluorescence. The relationship between them and clinicopathological features was analyzed relationship. Results: The number of mast cells in renal tissues of patients with ORG was significantly higher than that of the control group (P <0.01), which mainly distributed in the renal interstitium. The tubular and interstitial fibrosis of atrophy were more common and the tubulitis was seen. No infiltration of mast cells in the glomeruli, but infiltration of mast cells can be seen around the balloon; infiltration of mast cells can also be seen around the small blood vessels. The number of renal interstitial mast cells was positively correlated with body mass index (r = 0.364, P <0.05), systolic blood pressure (r = 0.459, (R = 0.324, P <0.05), serum creatinine (SCr), urinary N-acetylglucosidase (NAG) (R = 0.459, P <0.01), renal tubular atrophy (r = 0.470, P <0.01) and renal interstitial fibrosis (r = 0.669, P <0.01) ) Was negatively correlated with the level of glomerular filtration rate (eGFR) calculated by the MDRD formula (r = -0.559, P <0.01). The number of macrophages in the kidney of ORG patients was also significantly higher than that of the control group, and mainly distributed in the renal interstitium with more infiltration of inflammatory cells. There was also a small amount of infiltration in the glomerulus. The number of macrophages was positively correlated with the number of stromal cells (r = 0.476, P <0.01). Double immunofluorescence staining showed that macrophages and mast cells in the distribution of a certain consistency. Multivariate regression analysis showed that the extent of interstitial mast cell infiltration was an independent factor affecting eGFR levels. Conclusion: This study confirmed that the number of renal interstitial mast cells in ORG patients was increased, and mainly distributed in the peritubular and interstitial fibrosis and around the glomerular balloon, the number and BMI, blood pressure, renal tubular damage and renal function progression There is a significant correlation between mast cells involved in the occurrence and development of ORG.