1989年 · 第102卷第07期

In an attempt to clarify the relationship between hepatitis B virus (HBV) infection and glomerulonephritis (GN), and to explore the significance and possible mechanisms of HBV deposition in kidney, renal biopsy specimens obtained from 69 HBV carriers with various forms of GN and 69 age-, sex-, and renal histology-matched controls were studied with 4-layer PAP immunoperoxidase and indirect immunofluorescence techniques using monoclonal antibodies to HBV surface (HBsAg), core (HBcAg) and e antigen (HBeAg). The 3 HBV associated antigens were detected in the kidney in 18/18 patients with membranous nephropathy and in 21/26 (80.8%) patients with lupus nephritis regardless of whether HBV antigenemia was present or not. In certain types of primary GN, including IgA nephopathy, mesangial proliferative GN and membrano-proliferative GN, HBsAg in the kidney was more common in patients with HBs antigenemia than in those without it (49.1% vs 26.4%, P<0.05). No significant difference was observed between patients with and without HBV antigenemia in terms of HBcAg or HBeAg deposition in kidney. Immunopathological studies showed granular deposition of HBV antigens in exactly the same pattern as that of Ig(s) and complement components, and the characteristics of HBV deposition in the kidney were closely correlated with the extent of immune deposits. We conclude that the deposition of HBV-associated antigens in the kidney is often non-specific, although HBsAg is more commonly seen in some HBsAg carriers with GN. Massive immune complex deposits in the kidney seem to be the prerequisite of HBV deposition. Our findings do not confirm a pathogenic role for HBV in the development of GN, and the "HBV-complex nephritis" needs to be further evaluated.

In order to study the relationship between vascular endothelial cell (VEC) antigen system and systemic lupus erythematosus (SLE), including lupus nephritis, Terasaki’s microcytotoxicity test and indirect immunofluorescence were used to detect anti-VEC antibody. VEC was identified by electron microscopy. Sera of 21 SLE patients and of 100 healthy donors were examined. Among the 21 SLE patients evaluated, 17 had kidney injury and 13 were in active stage SLE. Results shows that anti-VES antibody was found in 76.2% of 21 SLE patients, while only 1% of the controls were positive (P<0.05). This antibody was detected in 84.6% of patients in active stage SLE and in 62.5% of patients in inactive stage (P>0.05). In patients with and without kidney injury, it was detected in 82.4% and 50%, respectively (P>0.05%).

Primary mesangial proliferative glomerulonephritis without IgA deposition (non-IgA MsPGN)is one of the most common types of glomerular disease in China. In an attempt to investigate its clinical and pathological features, we reviewed 77 such cases from 380 patients with primary glomerulonephritis taken renal biopsies during 1980-1987. Prodromal upper respiratory tract infection occurred in 31 cases (40%). In immunofluorescence microscopy, prominent IgG granular deposits in mesangium were observed in 45 cases (58%). These features are quite different from those in western countries, indicating it might have different pathogenetic processes. According to the severity of mesangial lesions, the 77 cases were divided into 3 groups: mild (55 cases), moderate (14) and severe (8). In the patients with mild mesangial lesion and massive proteinuria, the therapeutic response to prednisone was similar to that in adult minimal change disease. In the moderate and severe groups, there was a significantly higher incidence of superimposed tubulo–interstitial lesions associated with hypertension, persistant renal insufficiency and a poor response to prednisone. This work showed non-IgA MsPGN covered about 20% of our primary glomerulopathy, which may be related to a higher incidence of infection. It was suggested that minimal change nephritic syndrome, inspite of the variety of immunoglobulin mesangium deposits, could be treated as a single disease entity, and light microscopy is most important in offering prognostic information.

The main purpose of our study is to investigate the possible protective effects of Fructose 1-6 diphosphate (FDP) and Danshen 丹参 (Salvia Miltiozzhiza Bunze) on renal cortical Na-K-ATPase activity after renal ischemia and gentamicin nephrotoxicity. An 18.6% reduction in renal cortical Na-K-ATPase activity was shown after 30 min of renal pedicle clamping and 60 min of reflow, and a 32.5% reduction after 90 min of single injection of 100 mg/kg gentamicin. Light and electronic microscopy revealed no significant morphologic changes in both groups in the experiment. 4g/kg FDP and 18g/ kg Danshen were infused 60 min after reflow in the ischemic group, 90 min after injection of gentamicin in the gentamicin–treated group separately. The enzyme activity in the FDP-treated groups was found to be higher than that in the control kidneys while in the Danshen–treated groups no significant difference could be found. Our study showed that FDP and Danshen could prevent the decline of renal cortical Na-K-ATPase activity induced by ischemia and gentamicin. FDP could increase this enzyme activity while Danshen Showed no such direct effect.

Rat spleen lymphocytes (RSL) stimulated by mitogens in vitro were cultured on cryostat sections of rat kidney. After 36 hours glomerular polyanions (GPA) were stained with colloidal iron (CI). The results showed that the RSL stimulated with Con A were able to reduce GPA stainability as that treated with neuraminidase solution, and the effect was dose-dependent on Con A, whereas the supernatant of lymphocytes induced with Con A and the lymphocytes induced with PHA were not able to reduce GPA stainability. The result is in favor of the recent concept that the pathogenesis of MCN is associated with the loss of GPA which results from the dysfunction of the subpopulation of T lymphocytes.

Clinical, hemodynamic, and angiographic data were examined in 53 patients who underwent catheterization within 6 months of documented acute transmural myocardial infarction (MI). The patients were divided into two groups on the basis of presence (23 patients, group I) or absence (30 patients, Group II) of angina pectoris 1 month after MI. Group I patients had more severe coronary artery disease and a greater prevalence of multivessel disease than group II patients. Partial preservation of segmental left ventricular wall function in group I was related to the presence of collateral vessels. In patients with single vessel disease, incidence of spontaneous recanalization of the infarct–related artery was mote common in group I as compared with those in group II. It is concluded that angina pectoris after MI suggests multivessel disease or infarct–related artery recanalization. Coronary angiography may be advised in these patients in order to select adequate therapeutic interventions and improve prognosis.

T-lymphocyte subsets, B-lymphocyte, immunoglobulins and complement were studied in 38 children with Henoch Schonlein Purpura (HSP) in the acute stage. They had significantly lower CD3 percentage and lymphocyte blastogenesis rate, greater CD8 variation coefficient and B-lymphocyte percentage and higher levels immunogloblins (IgA, IgG, IgM) and complement 3 than the controls. 21(55%) of them had a low CD8 percentage. The results indicated that children with HSP had low T-lymphocyte percentages and function, high immunoglobulins, normal or elevated complement. On the other hand, no significant differences were found in the T-lymphocyte subsets values among healthy children aged 7-11 years. The normal values of T cell subsets in 35 normal controls were CD3 66-70%, CD4 37-41%, CD8 28-32%, respectively.

In order to understand the mechanism of immunosuppression caused by infusion of placental gamma globulin (PGG) in patients with renal allografts, rheumatoid arthritis, and graft–versus–host disease (GVHD) following bone marrow transplantation (BMT), we have examined the effect of PGG in vitro and in a model of the xenogeneic, local graft–versus–host reaction (LGVHR). PGG inhibited lymphocyte proliferation in mixed lymphocyte cultures (MLC) (P<0.005) and depressed interleukin-2 (IL-2) levels in such cultures at 72 hours (P<0.01). In contrast phytohemagglutinin (PHA)– and pokeweed mitogen (PWM)–induced T and B lymphocyte blastogenesis was not affected by such PGG treatment. PGG neither decreased the [3H] TdR pulse incorporation in unstimulated lymphocytes nor affected cell viability. Cell cycle analysis by flow cytometry showed that PGG reduced the percentage of cells in S and G2, M phases during the MLC, but did not alter cell cycling during PWM-stimulated proliferation. An immunosuppressive effect of PGG on the LGCHR was tested in a model of intracutaneous transplantation of PGG–treat human lymphocytes into cyclophosphamide–immunosuppressed rats. Lymphoprepseparated human tonsillar lymphocytes were incubated with RPMI-1640 buffer containing: (1) PGG, 4 mg/ml, (2) human plasma albumin, 4 mg/ml, (3) mitomycin-C, 25 μg/ml, or (4) no additive. Cell of each preparation (3×107 cells in 0.1 ml) were injected intracutaneously into cyclophosphamide-treated male rats at separate abdominal locations. A fifth site received only the buffer solution. Five days after injection of cells, each rat received [125I]IUdR (10 μCi) intraperitoneally and was killed after 5 hours. For each site of injection, the diameters of induration were measured and 125I was counted. There was no difference between buffer–treated and a ibumin–treated groups either in the diameter of the area of induration (t=0.66; P>0.5) or in radioactive counts (t=0.22; P>0.05). In the PGG–treated group, the induration and radioactivity measurements were significantly less than in control groups (t=3.72 and P<0.1; t=2.62 and P<0.02, respectively). Cytophilic antibodies in PGG were thought to inhibit an early phase of T cell activation, and not to be cytotoxicity. In the LGVHR, the immune response might be abrogated either by immuno-regulatory suppression of T cell function or by toxicity to the infused lymphoid cells. For some clinical purposes, immuno-modulating, human antibodies might be preferred to murine, monoclonal antibodies.

A new combined measure of nerve transfer, including antebrachial medial cutaneous nerve, and free musculocutaneous flap transfer was applied to the treatment of irreversible avulsion of the brachial plexus. 12 patients underwent this operation for restoring elbow and finger flexion. Good result was obtained in 71% for elbow and 60% for finger flexion restoration. The definition of irreversible avulsion and the methods, key points and value of the operation are described and discussed in detail.

Intramedullary pressure in the proximal femur was measured before and after treatment of congenital dialocation of the hip. The intramedullay pressure before treatment was higher than that of the control group , and after treatment it was lower as a whole; in the close reduction group the pressure decreased as compared with the operation group. In 8 hips, stress test yielded negative results. These findings suggested the characteristics of arteriai blockage may be that the potential cause of avascular necrosis of the femoral head after treatment of congenital dislocation of the hip.