单纯性血尿患儿肾组织免疫病理及肾小管血管内皮细胞生长因子的表达  

Renal Immunopathology and Expression of Vascular Endothelial Growth Factor of Renal Tubule in Children with Single Hematuria

作　　者：董泽伍[1] 李晓忠[2] 杨晓春[1] 朱雪明[3] 王兴东[3] 

机构地区：[1]淮安市第一人民医院儿科,江苏淮安223300 [2]苏州大学附属儿童医院肾内科,江苏苏州215000 [3]苏州大学附属儿童医院病理科,江苏苏州215000

出　　处：《实用儿科临床杂志》2009年第5期336-338,382,共4页Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金项目资助(30271234)

摘　　要：目的观察单纯性血尿患儿肾组织免疫病理变化及肾小管血管内皮细胞生长因子(VEGF)的表达,探讨VEGF在单纯性血尿发病机制中的作用。方法选取2004年1月-2007年3月在苏州大学附属儿童医院就诊并行肾活检的32例单纯性血尿患儿,均于肾活检后,取其部分肾组织经快速冷冻切片行常规病理和免疫荧光分析。同时采用免疫组织化学方法检测其肾小管VEGF表达情况,并进行统计学分析。结果不同临床类型的单纯性血尿患儿肾组织病理主要表现为系膜增生性改变,其中轻度增生和弥散性增生分别占37.50%和46.88%,少数伴局灶/节段性细胞增生、坏死、纤维化和肾小球硬化。不同临床类型、病理类型的病例均可见IgA和(或)IgM沉积,其中系膜区以IgA沉积为主者占62.50%,且常伴IgM和(或)IgG沉积;以IgM沉积为主(不伴IgA)者占37.50%,其中仅有IgM者9例,占28.13%,少数伴IgG沉积。与对照组比较,各单纯性血尿组患儿肾小管VEGF表达均显著降低(P<0.05)。不同病理类型间弥散性系膜增生(Ⅲb级)患儿肾小管VEGF阳性表达率略低于轻微改变(Ⅰ级)患儿,二者比较无显著性差异(P>0.05)。伴局灶/节段性改变(Ⅱ级)的患儿肾小管VEGF阳性表达率均较Ⅰ级和Ⅲb级患儿降低,其中Ⅱb加Ⅲb与Ⅲb组间比较无显著性差异(P>0.05),Ⅰ级与Ⅱb加Ⅲb和Ⅱa加Ⅲb级间,及Ⅲb级与Ⅱa加Ⅲb级间比较均存在显著性差异(Pa<0.05);Ⅱa加Ⅲb级无症状血尿组肾小管VEGF表达率低于Ⅱb加Ⅲb组,二组间比较无显著性差异(P>0.05)。结论单纯性血尿患儿肾组织主要表现为系膜增生性改变,伴IgA和(或)IgM沉积,提示免疫炎性反应在本病发病机制中起重要作用。各组病例肾小管VEGF表达降低,肾脏保护因素减弱,可能也是单纯性血尿发生、发展的重要影响因素。ObjectiveTo observe the renal immunopathologic changes and expression of vascular endothelial growth factor（VEGF） of renal tubule in children with single hematuria,and to explore the role of VEGF in the pathogenesy.MethodsThirty-two children suffered from single hematuria,hospitalized and performed renal biopsy in Children＇s Hospital Affiliated to Soochow University were adopted between Jan.2004 and Mar.2007,after biopsy,part of renal tissue were harvested and made into frozen sections,and analysis were followed by routine pathology and immunofluorescence.Meanwhile,the expression of VEGF of renal tubule was detected by immunohistochemistry,and statistical analysis was followed.ResultsChildren suffered from different clinical types of single hematuria mainly presented mesenterium proliferative changes,and the percentage of minor and diffuse proliferation were 37.50% and 46.88% in total patients respectively,few children appeared focal /segmental cell proliferation,necrosis,fibrosis and glomerular sclerosis.Deposition of IgA and（or） IgM were seen in different clinical and pathological types of cases,of which deposition of mainly IgA in mesenterium area covered 62.50% in all cases,many of them with IgM and（or） IgG.Deposition of mainly IgM（without IgA） was 37.50%,9 cases had only IgM deposition,which was 28.13% of all cases,few with IgG deposition.Contrasting with control group,the expression of VEGF of renal tubule of the sufferers in each single hematuria group was decreased（P〈0.05）.Between different pathological types,tubular positive expression rate of VEGF in children with diffused mesenterium proliferation（grade Ⅲb） were lower than the children with minor changes（grade Ⅰ）,and the difference had no significance（P〉0.05）.The expression of VEGF of renal tubule in children with focal/segmental changes（grade Ⅱ） were decreased than grade Ⅰ and grade Ⅲb,of which the differences were not significant between Ⅱb plus Ⅲb and Ⅲb group（P〉0.05）,and significant di

关 键 词：单纯性血尿 血管内皮细胞生长因子 系膜增生 儿童 

分 类 号：R726.9[医药卫生—儿科]