激素耐药性肾病综合征肾小管上皮细胞-间充质转化临床意义研究  

Significance of epithelial to mesenchymal transition in children with steroid-resistant nephrotic syndrome

作　　者：周频[1] 何庆南[1] 谭爱斌[1] 李晓燕[1] 姜莹[1] 黄爱文[1] 易著文[1] 

机构地区：[1]中南大学湘雅二医院小儿肾脏病研究室,长沙410011

出　　处：《中国实用儿科杂志》2010年第3期191-194,共4页Chinese Journal of Practical Pediatrics

基　　金：中南大学研究生教育创新工程项目资助(项目编号:2340-77306)

摘　　要：目的探讨肾小管上皮细胞-间充质转化(EMT)与肾脏病理进展及原发性肾病综合征(INS)糖皮质激素(GC)耐药的关系。方法2005年9月至2007年12月在中南大学湘雅二医院儿科住院行肾穿刺活检的INS患儿40例,分为激素耐药性肾病综合征(SRNS)组(20例)和激素敏感性肾病综合征(SSNS)组(20例)。免疫组化双染法检测INS患儿和5例正常对照组儿童肾组织中细胞角蛋白(CK)和波形蛋白(vimentin)的表达,肾脏病理评分半定量评价肾组织病理损害程度。结果SRNS组肾小管-间质病理评分显著高于SSNS组(P<0.05);正常对照组肾小管上皮细胞内只表达CK,不表达vimentin;INS肾小管上皮细胞均不同程度表达vimentin;SRNS组肾组织CK表达较SSNS组显著降低[分别为(66.25±12.13)%和(76.64±7.64)%,P<0.05],vimentin表达较SSNS组显著增高[分别为(11.51±7.48)%和(4.98±2.27)%,P<0.05];不同肾小管-间质病变(轻、中、重度)组肾小管上皮细胞内CK和vimentin表达量的差异均有统计学意义[CK表达量分别为(79.97±3.70)%、(65.47±7.93)%和(48.47±5.98)%,P<0.05];vimentin表达量分别为(4.74±1.84)%、(9.65±5.10)%、(23.60±7.72)%,P<0.05];肾小管-间质病理评分与肾小管上皮细胞CK表达呈负相关(r=-0.887,P<0.01),与vimentin的表达呈正相关(r=0.868,P<0.01)。结论肾病综合征肾组织的肾小管上皮细胞存在不同程度的肾小管上皮细胞-间充质细胞转化(EMT)现象,尤以SRNS为甚;检测肾组织EMT水平可能有助于判断INS的预后。Objective To study the relationship of epithelial to mesenchymal transition with renal pathological progression and slueoeorticoid resistance in idiopathic nephrotic syndrome. Methods The different expressions of CK and vimentin were detected with the immunohis/ochemistry double staining technique in renal biopsy tissnes obtained from 20 SRNS children, 20 SSNS children and 5 nephreclomized healthy children, respectively. Renal histopathological lesion was evaluated by the semi-quantitative counting scores. Results The tnbulointerstitial pahological counting scores in SRNS grnup was higher than thai in SSNS group （P 〈 0.05）. There was no vimentin hut CK expression on lhe tubular epithelium in the control group and different levels of expression of vimenlin were found in INS group. In SRNS group, the expression of CK was lower than SSNS group [（66.25 ± 12.13）% , （76.64 ± 7.64） , P 〈 0.05] and the expression of vimentin was higher than SSNS grnup [（ 11.51 ± 7.48）%, （4.98 ± 2.27）% , P 〈 0.05]. With the raising grade of tubulointerstitial lesions （graded as mild, moderate and severe lesions） , the expression of vimentin was increased wheres expression of CK was decreased [vimentin, （4.74 ±1.84） %, （ 9.65 ± 5.10） % , （ 23.60 ± 7.72 ） % , P 〈 0.05]; CK, （79.97 ± 3.70）% , （65.47 ± 7.93）% , （48.47 ±5.98）% , P 〈 0.05]. The counting scores of the tuhulointerstitial lesions were positively correlated with the level of vimentin expression （r = 0.868, P 〈 0.01 ） , buinegatively correlated with CK expression level in renal tissues （r =-0.887, P 〈 0.01）. Conclusion The phenomenon of EMT exists difterenlly in renal lissues of INS eases and the degree of these is higher in SRNS group. The detection of EMT in renal tissues can beadopted to tell the different prognoses in INS.

关 键 词：肾病综合征 细胞角蛋白 波形蛋白 糖皮质激素 

分 类 号：R72[医药卫生—儿科]