肾小管上皮细胞转分化与IgA肾病预后的相关性分析  

Relationship between transdifferentiation of renal tubular epithelial cells and the prognosis of IgA nephropathy

作　　者：姚俊霞[1] 彭峰[2] 刘涛[2] 李斌[3] 易建华[2] 朱礼国[2] 吴人亮[1] 

机构地区：[1]华中科技大学同济医学院,武汉430000 [2]郧阳医学院附属太和医院,湖北十堰442000 [3]郧阳医学院,湖北十堰442000

出　　处：《广东医学》2008年第3期406-408,共3页Guangdong Medical Journal

基　　金：湖北省教育厅重点科研项目(编号:B200624021)

摘　　要：目的检测IgA肾病中肾小管上皮细胞转分化及小管间质纤维化程度,并探讨其与IgA肾病预后的相关性。方法选取74例IgA肾病患者的肾穿活检组织,分为3组:轻度系膜增生组(27例)、局灶增生组(28例)和增生硬化组(19例)。检测患者的血压、血清肌酐及24h尿蛋白定量。采用免疫组化及Masson方法观察肾小管间质内α-SMA,Vimentin,TGF-β和胶原纤维的表达。结果IgA肾病患者的血压、血清肌酐及24h尿蛋白定量随病理分级增加逐渐升高,增生硬化组患者的各项临床指标均显著高于轻度增生组和局灶增生组(P<0.01),局灶增生组24h尿蛋白定量与轻度增生组间差异有显著性(P<0.01);IgA肾病小管间质α-SMA,Vim-entin及TGF-β表达及表示纤维化程度的胶原纤维表达随分级增加逐渐增高,各组间差异有显著性(P<0.05或P<0.01)。IgA肾病组织中α-SMA,Vimentin及胶原纤维与临床指标血清肌酐、24h尿蛋白定量中度相关(P<0.05),Vimentin与α-SMA、胶原纤维的表达均呈高度相关(P<0.01)。结论IgA肾病中肾小管上皮细胞转分化程度与小管间质纤维化及肾功能异常具有相关性,肾小管上皮细胞转分化可能是肾脏预后不良的关键因素之一,浕-SMA和Vimentin的表达可能作为评估临床IgA肾病预后指标之一。Objective To investigate the transdifferentiation of renal tubular epithelial cells and interstitial fibrosis in IgA nephropathy tissues and its relationship with the prognosis. Methods Renal biopsy specimen were collected from 74 patients with IgA nephropathy and divided into mild proliferation group, focal proliferation group and proliferation - sclerosis group according to the glomerular lesions. Blood pressure, 24 h urinary protein excretion and serum creatinine were monitored. The expressions of α- SMA, Vimentin, TGF-β and collagen fibers in renal tissues were examined by immunohistochemistry and Massonstaining. A correlation analysis wasperformed. Results The histopathological grade was positively correlated with interstitial fibrosis, blood pressure, 24 h urinary protein and serum creatinine. The levels of α- SMA, Vimentin, TGF-β and collagen fibers were significantly increased with advancing of histopathological grade（ P 〈 0. 01 ）. There was a correlation between the histopathologic indicators and the renal function （ P 〈 0. 01 ）. Conclusion These observations suggest that transdifferentiation of tubular epithelial cells has a role in progressive renal fibrosis, α- SMA and Vimentin may be used as a prognostic indicator of the clinical outcome of IgA nephropathy.

关 键 词：肾小球肾炎 IGA 肾小管上皮细胞 转分化 纤维化 预后 

分 类 号：R692.33[医药卫生—泌尿科学] R586[医药卫生—外科学]