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目的 比较霉酚酸酯（ＭＭＦ）联合糖皮质激素治疗弥漫增生性狼疮肾炎前后肾组织的活动性和慢性病变的变化并探讨其机制。方法９例弥漫增生性狼疮肾炎患者在ＭＭＦ和糖皮质激素治疗后６～７个月接受了重复肾话检。应用天狼星红行胶原染色。Ｔ细胞、单核／巨噬细胞、增殖细胞、骨桥蛋白（ＯＰＮ）、纤连蛋白（ＦＮ）、α－平滑肌肌动蛋白（α－ＳＭＡ）及ＴＧＦ－β１应用ＳＰ法行免疫组织化学染色。计数细胞及应用图像分析对染色行定量评估。对组织病理表现行话动指数（ＡＩ）和慢性指数（ＣＩ）评分，观察上述指标在治疗前后的变化，分析其间的相关性。结果（１）治疗后ＡＩ下降，小球及小管间质浸润的Ｔ细胞、单核／巨噬细胞减少，小球及小管间质细胞的增殖率降低；ＯＰＮ表达减少并与小管间质的单核／巨噬细胞数正相关。（２）治疗后 ＣＩ变化不显著，ＦＮ在小球及小管间质的面积比、胶原在小管间质的面积比及。ＳＭＡ、ＴＧＦ－β１的表达在治疗前后差异无显著性意义。（３）治疗后间质的Ｔ细胞数与胶原在小管间质的面积比正相关，单核／巨噬细胞数与胶原、ＦＮ、α－ＳＭＡ在小管间质面积比正相关。结论ＭＭＦ联合糖皮质激素治疗弥漫增生性狼疮肾炎可以通过下调黏附分子减少单该巨噬细胞和淋巴细胞?
Objective To compare the changes of activity and chronic pathological changes of renal tissue before and after treatment of diffuse proliferative lupus nephritis with mycophenolate mofetil (MMF) and glucocorticoids and to explore its mechanism. Methods Nine patients with diffuse proliferative lupus nephritis received repeated renal speech tests 6 months to 7 months after MMF and glucocorticoid therapy. Application Sirius red line collagen staining. T cells, monocytes / macrophages, proliferating cells, osteopontin (OPN), fibronectin (FN), α-SMA and TGF-β1 were detected by immunohistochemistry . Count cells and apply image analysis to quantitatively assess staining. Histopathological changes were evaluated according to the words of speech activity index (CI) and activity index (CI). The changes of these indexes before and after treatment were observed and their correlations were analyzed. Results (1) After AI decreased, the number of T cells and monocytes / macrophages infiltrating into the small intestine and tubules reduced, the proliferation rate of glomerulus and tubulointerstitial cells decreased; the expression of OPN decreased, The number of nuclear / macrophages was positively correlated. (2) CI did not change significantly after treatment, the area ratio of FN in the globules and tubulointerstitial area and the area ratio of collagen in the tubulointerstitium. The expression of SMA and TGF-β1 had no significant difference before and after treatment. (3) There was a positive correlation between the number of T cells in the stroma and the area of collagen in the tubulointerstitial. The number of monocytes / macrophages positively correlated with the area of tubulointerstitial of collagen, FN and α-SMA. Conclusions MMF plus glucocorticoids in the treatment of diffuse proliferative lupus nephritis can reduce single macrophages and lymphocytes by down-regulating adhesion molecules.