1型糖尿病における傍糸球体装置のT cell浸潤は糖尿病性腎症の発症に関与するか  [in Japanese] T Cell Infiltration in the Juxtaglomerular Apparatus as an Indicator of Diabetic Nephropathy in Type 1 Diabetic Patients  [in Japanese]

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Abstract

腎症前期〜早期の1型糖尿病患者(10歳〜30歳,罹病期間2〜20年)の腎生検組織を用い,免疫組織化学法でTリンパ球の傍糸球体装置(JGA)への浸潤の有無を検索し,浸潤のある群(P群:37例)とない群(N群:40例)とで腎組織形態と機能の差を検討した。年齢,性別,発症年齢,HbAlc,血圧,腎機能,尿中アルブミン排泄量は2群間で差はなかったが,罹病期間はP群が有意に短かった。末梢係蹄開大度と有効濾過面積はP群で増加していた。若年1型糖尿病患者の48%にT cellのJGAへの浸潤を認めたことは,1型糖尿病発症の一因である自己免疫機構の腎症発症への関与を示唆し,P群で罹病期間が短く,糸球体の有効濾過面積も増加していることは,前期〜早期腎症の初期の変化が有効濾過面積の増加であると推察され,腎症進展の機序を考える上の一助と考えられた。

Overt diabetic nephropathy (DN) develops in 20〜40% of Type 1 insulin-dependent diabetic patients (Type 1D). It is well known that hyperglycemia is a major risk factor for DN. Recently another factor such as renin-angiotensin system (RAS) is considered to be an important factor in renal extracellular matrix dynamics in diabetes. This study considers the frequency of juxtaglomerular apparatus (JGA) T cell infiltration in young Type 1 diabetic patients (10〜30 years old, 2〜20 years of duration of diabetes, albumin excretion rate<100μg/min) by immunohistochemical staining and examined whether there were renal structural or functional differences between Type 1D patients with and without JGA T cell infiltration. Out of 91 patients whose number of glomerulus or JGAs are enough for judgement of T cell infiltration, 37 cases showed positive staining (P), 40 cases showed negative staining (N) and 14 cases showed borderline staining for T cell infiltration. There was no significant difference between P and N groups in category of age, age of onset of Type 1D, gender, albumin excretion rate, glomerular filtration rate, HbAlc, mean blood pressure. Only the duration of Type 1D was significantly shorter in the P group compared to the N group. Vv (Mes/glom) was increased only in N group compared to normal. GBM width was increased in both P and n groups compared to normal, but there was no significant difference between two groups. Sv (PGBM/glom) and filtration surface per glomerulus was increased in the P group compared to N group and normal. JGA T cell infiltration was detected in 48% of young Type 1D which indicate that autoimmunity might affect the onset and the progress of DN. From the fact that the duration of Type 1D was shorter and the filtration surface was increased in the P group, we may conclude that the morphological changes at the early stage in the DN are the increase of filtration surface.

Journal

  • Kitasato medicine

    Kitasato medicine 30(6), 432-438, 2000-12-31

    Kitasato University

Codes

  • NII Article ID (NAID)
    110004698336
  • NII NACSIS-CAT ID (NCID)
    AN00052147
  • Text Lang
    JPN
  • ISSN
    03855449
  • Data Source
    NII-ELS 
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