乙型肝炎病毒相关性膜性肾病患儿足细胞缺失的研究  

Podocyte depletion in children with hepatitis B virus-associated membranous nephropathy

作　　者：张瑜[1] 周建华[1] 王洪涛[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院儿科,武汉430030

出　　处：《中华儿科杂志》2007年第5期344-348,共5页Chinese Journal of Pediatrics

摘　　要：目的观察乙型肝炎病毒相关性膜性肾病(HBV-MN)患儿肾小球足细胞数量的变化及意义。方法以 Wilms 瘤蛋白1(WT1)为足细胞核的特征性标记,通过免疫组织化学方法对19例经肾穿刺活检确诊为 HBV-MN 患儿及8例同期肾活检诊断为薄基底膜病(TBMD)的患儿(对照组)肾脏病理切片的足细胞进行特异性染色,采用 Weibel-Gomez 点计数方法测定单位肾小球足细胞绝对数目(Npodo)、足细胞相对密度(Nv)及单个肾小球毛细血管簇体积(V),比较两组间差异,并分析其与血清免疫学检查、蛋白尿程度及肾组织病理改变等指标间的关系。结果①19例 HBV-MN 患儿的超微病理结果均显示存在不同程度的足突融合,3例有足突微绒毛化,4例出现足细胞肿胀,1例足细胞空泡变性,2例可见足细胞崩解;②HBV-MN 患儿 Npodo 及 Nv 均较对照组显著下降(P<0.01);③ Npodo 的减少与肾小球中 HBsAg 的沉积强度相关,HBsAg 免疫荧光强度≥(++)患儿的平均 Npodo 明显低于荧光强度<(++)者(p<0.01);但 Npodo 及 Nv 的下降均与肾脏病变病理分期无显著相关性;④Nv 减少与蛋白尿程度相关,24 h尿蛋白定量<2 g患儿的 Nv 明显高于>2g 者(P<0.05);⑤肾小球足细胞数量与血清补体 C_3,水平呈正相关(r=0.548,P=0.028),而与血清白蛋白水平无显著相关性(r=-0.037,P=0.891)。结论 HBV-MN 患儿均存在不同程度的足细胞损伤、缺失,Npodo 减少可能在 HBV-MN 的发病中起重要作用。Objective Hepatitis B virus-associated membranous nephropathy （HBV-MN） is a disease characterized by podocytopathy. Podocyte is a terminally differentiated cell with limited capability of proliferation. Thus, damage of podocyte might result in decreased cell number, and then lead to the development of marked proteinuria and glomerulosclerosis. The present study aimed to investigate the changes of glomerular podocyte number in the children with hepatitis B virus-associated membranous nephropathy （ HBV-MN）, and their significance in the pathogenesis of HBV-MN. Methods Podocytes were identified through specific immunohistological staining of Wilms tumor gene protein 1 （WT1）, a characteristic marker for podocyte nuclei, and podocyte numerical density （ Nv）, mean glomerttlar tuft volume （V） and the podocyte number per glomerulus （Npodo） were estimated through Weibel-Gomez method in 19 children with biopsy-proven HBV-MN and 8 children with thin basement membrane disease （control group）, and analyses were made for possible correlation with clinical, serological and pathological data. Results Among the 19 cases with HBV-MN, 3 showed microvillus-like foot process of podocytes, granular degeneration of podocyte were found in 4 cases, vacuolization in 1 case and podocyte detachment in 2 cases. Nv and Npodo were significantly decreased in children with HBV-MN compared with control group （t = 12. 851, P = 0. 0002 and t = 6. 433, P = 0. 0002, respectively）. Moreover, the number of podocytes decreased more significantly in patients with stronger HBsAg deposition （ 〉 ＋ ＋ ） than those with weak HBsAg deposition （ ≤ ＋ ＋ ）, P = 0. 004, but no significant difference was found between patients with phase Ⅲ or Ⅳ of HBV-MN and those with phase Ⅰ or Ⅱin podocyte number per glomerulus （P = 0. 5262） and podocyte numerical density （ P = 0. 3564）. Podocyte numerical density decreased more significantly in patients with massive proteinuria （ ≥ 2 g/24 h） than those with

关 键 词：肝炎病毒 乙型肾小球肾炎 膜性 上皮细胞 

分 类 号：R726.9[医药卫生—儿科]