| Backgroud and Objective Lupus nephritis is the most frequent and serious organ lesion of systemic lupus erythematosus, the severity is directly correlated with prognosis of SLE. Clinical and pathological manifestations of lupus nephritis are highly variable, still immunologic pathogenesis varies from one class to another. Relapse is the major problem in therapy and usually several immunosuppressive regimens longly are required. So the analysis of relationships among clinical, renal pathological and immunological aberration contribute to the understanding of the nature of the disease and provide evidences for therapy. Currently, some studies have illustrated the disequilibrium of cytokines played an essential role in the development and progression of the disease. Interreaction of pro-inflammatory and anti-inflammatory cytokines might be the key mechanism, reflecting some steps of the tong linkage, so researches have been focus on finding initial or vital step of the long linkage as a target of the therapy. By studying clinicopathological features of lupus nephritis, detecting expressions of IL-18, TGF-β1,α-SMA in lupus nephritis, we try to explore their pathogenic roles and provide new therapeutic targets for lupus nephritis. Materials and Methods 90 cases of lupus nephritis were selected from the Department of Pathology, West China hospital, Sichuan Universitity during January 2002 to December 2006. All patients fulfilled at least four items of the ACR-criteria of 1997, with clinical manifestation of renal lesions, complete histology, and laboratory examination records. The histological classifications were categorized according to the 2003 ISN /RPS classificattion system. All cases were studied by clinical data analysis, light microscopy, immunofluorescence examination. Among them, 13 cases were examined by electron microscopy. The immunostainings were performed on 60 cases which contained≥5 glomeruli. IL-18 and TGF-β1 were detected by polyclonal antibodies, whileα-SMA was detected by monoclonal antibody. The data were analysed by SPSS 13.0 software.Results Of 90 LN patients, 80 females and 10 males. Female patients are mainly in classⅣandⅤ, and Males are mainly in classⅢ,Ⅳ,Ⅴ+ⅢandⅤ+Ⅳ. Immunofluorescence usually shows full-house pattern, but occasionally pauci-immune deposit can be seen. The titer of serum ANA isn't correlated with LN AI. Lower C3, C4 are negatively correlated with LN AI.Proteinuria and Anti-dsDNA antibody are positively correlated with LN AI.Heavy proteinuria and renal insufficiency were often seen in classⅣpatients, besides, anti-dsDNA antibody were more frequent in classⅤ+Ⅳ. Nephrotic syndrome and acute renal failure can be seen in mild lupus patients.Extrarenal manifestations can be seen easily in classⅢpatients.The expression of IL-18, TGF-β1 in LN renal tissue are both significantly enhanced than normal control renal tissue, still the intensity and extensity vary from one class to another and show positive correlation with LN AI, and proteinuria. The expression modality of IL-18, TGF-β1 are very similar. The glomerular expression ofα-SMA is positively correlated with LN AI,especially in DPLN. Besides, the interstitial expression ofα-SMA is positively correlated with LN CI. The expressions of IL-18, TGF-β1 andα-SMA are positively correlated with each other.Conclusions This group cases are dominated by classⅣ. ClassⅤ+ⅢandⅤ+Ⅳare not rare. Male patients are more serious. Different classes present different clinical and immunological features, reflecting different immunopathologenesis and affecting the project of immunosuppressive therapy. The overexpression of IL-18, TGF-β1 andα-SMA in lupus renal tissue are correlated with AI. The three markers are correlated with each other.IL-18, as a pivotal of Th1 type cytokine reaction, may located in the upstream of cytokine reactive linkage, participating lupus renal lesion partly by facilitating overexpression of TGF-β1 andα-SMA. |
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