急慢性马兜铃酸肾病的临床病理特点及其病理机制  

Study of the clinico-pathological characters of acute, chronic aristolochic acid nephropathy and the pathological mechanism

作　　者：吴杰[1] 陈香美[1] 师锁柱[1] 

机构地区：[1]解放军总医院肾病科解放军肾病中心暨重点实验室,北京100853

出　　处：《中华检验医学杂志》2005年第6期587-590,共4页Chinese Journal of Laboratory Medicine

基　　金：国家重点基础研究发展规划"973"资助项目(G2000057000);国家自然科学基金创新研究群体科学基金资助项目(30121005)

摘　　要：目的分析急、慢性马兜铃酸肾病的临床与病理学特点,探讨其慢性化的病理学机制。方法回顾性分析26例明确诊断为马兜铃酸肾病患者的临床与病理资料,依照病理特点分为急、慢性组,应用免疫组织化学方法观察患者肾活检组织标本中III型胶原、I型纤溶酶原激活物抑制因子(PAI1)、基质金属蛋白酶组织抑制物1(TIMP1)、增殖细胞核抗原(PCNA)的表达。结果26例马兜铃酸肾病患者,急性组11例,慢性组15例(其中女性12例,男性3例)。慢性组用药时间[(142.3±52.7)个月]明显长于急性组[(4.5±2.7)个月],在临床指标上合并高血压的比例高、收缩压水平高[慢性组平均收缩压(156.7±32.4)mmHg(1mmHg=0.133kPa),急性组平均收缩压(127.3±24.2)mmHg]贫血重、尿蛋白少(P值均<0.05);在病理改变上球性硬化、间质纤维化、肾小管萎缩、血管损伤的程度重(P值均<0.05);间质、肾小管上皮细胞III型胶原、PAI1、TIMP1表达明显增强(P值均<0.05)。结论急、慢性组马兜铃酸肾病患者临床与病理特点不同;PAI1、TIMP1在其慢性化进展中可能起重要作用。Objective To investigate the clinico-pathological characters of acute and chronic Aristolochic acid nephropathy, and analysis the pathological mechanism of chronic Aristolochic acid nephropathy.Methods 26 cases of aristolochic acid nephropathy diagnosed in our department were examined. They were divided into acute and chronic group by their pathological characters. Immunohistochemical staining for the expression of collagen III, PAI-1, TIMP-1 and PCNA was done in renal biopsy specimens.Results There were 11 acute cases and 15 chronic cases. Compared with acute cases, there were more female, longer duration of the medicine intake[ (142.3±52.7 months of chronic cases and 4.5 ± 2.7 months of acute cases), higher degree of hypertension[(156.7±32.4) mm Hg of chronic cases and 127.3±24.2 mm Hg of acute cases], 24 hour urinary protein,anemia, glomerulosclerosis, tubular atrophy, interstitial fibrosis and artery lesions in chronic patients(Pall< 0.05). The expressions of collagen III,PAI-1, TIMP-1 were all increased in accordance with the increased degree of interstitial fibrosis in chronic patients (Pall<0.05).Conclusions There are different characters of acute and chronic Aristolochic acid nephropathy. PAI-1 and TIMP-1 may contribute to the progressive of this disease.

关 键 词：慢性马兜铃酸肾病 Ⅰ型纤溶酶原激活物抑制因子(PAI-1) 临床病理特点 增殖细胞核抗原(PCNA) 病理机制 基质金属蛋白酶组织抑制物 免疫组织化学方法 TIMP-1表达 肾小管上皮细胞 临床与病理特点 平均收缩压 肾病患者 Ⅲ型胶原 

分 类 号：R692.3[医药卫生—泌尿科学]