肾小球疾病中转化生长因子-β_1与肌成纤维细胞的表达及意义  

Expression of Transforming Growth Factor-β_1 and Myofibroblasts in Patients with Primary Glomerulonephritis

作　　者：臧秀娟[1,2] 刘梅[1,2] 宋莹[1,2] 郑峰[1,2] 夏燕萍[1,2] 王红蕊[1,2] 

机构地区：[1]上海市松江区中心医院 [2]上海交通大学附属第一人民医院松江分院,上海201600

出　　处：《中国中西医结合肾病杂志》2010年第5期386-390,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：上海交通大学附属第一人民医院松江分院基金资助项目(No.BY09C06)

摘　　要：目的:探讨肾小球疾病中转化生长因子-β1(TGF-β1)与肌成纤维细胞的α-平滑肌肌动蛋白(α-SMA)表达及其对肾硬化的影响作用。方法:将原发性肾小球肾炎患者42例根据不同病理类型分为4组,利用肾活检组织免疫组织化学染色观察TGF-β1、α-SMA、胶原Ⅲ(Col-Ⅲ)表达与患者血肌酐(Scr)和内生肌酐清除率(Ccr)之间的相关性,根据镜下免疫组织化学染色在肾小球、肾小管间质中的着色深浅程度及分布,用MetuMorph图像处理系统,测出灰度按半定量方法,进行统计学分析。结果:不同病理类型的肾小球肾炎有不同的表达,随硬化程度的加重,其表达显著增加。TGF-β1表达主要分布于肾小球的系膜基质区、新月体中和小管间质的肾小管上皮细胞胞浆、间质成纤维细胞胞浆中、间质基质区和炎性细胞大量浸润区。α-SMA的表达在MsPGN组最高,而FSGS,SGN肾小球上几乎无α-SMA的表达,在肾间质中α-SMA的表达,随病变程度的加重,其表达显著增加。肾硬化中TGF-β1表达量与患者Scr和Ccr之间呈正相关,α-SMA、Col-Ⅲ在肾小管间质的表达量与患者Scr和Ccr之间呈正相关。结论:在肾硬化形成过程中,TGF-β1是重要的促发因素,肾硬化病变的初期,炎症反应使巨噬细胞和成纤维细胞等活化,分泌TGF-β1增加,TGF-β1进一步刺激(肾小管上皮细胞)TEC和成纤维细胞等,使表型转化为Myo-FB,Myo-FB合成和释放TGF-β1,进入恶性循环,最终导致肾硬化形成。Objective：To discuss the expression of transforming growth factor-β1 and myofibroblasts in patients with primary glomerulonephritis and the effect on the renal scarring.Methods：Total forty-two patients with primary glomerulonephritis who were diagnosed by renal biopsies.They were divided into four groups according to types of their biopsies.According to the intensity and distribution of staining of TGF-β1,α-SMA and Col-Ⅲ,the grey were evaluated in the metamorph image system and calculated by semi-quantitatively analysis.Results：With the development of renal scarring,it showed significant difference. TGF-β1 were expressed in mesangial region of glomeruli,cytoplasmic area of tubular epithelial cells,interstitium and so on.α-SMA cells were expressed in mesangial region of glomeruli.The expression intensity of TGF-β1 in glomeruli was found a close positive correlation to Scr and Ccr in patients.The expression intensity of TGF-β1,α-SMA and Col-Ⅲ in the tubulointerstitial was found a close positive correlation to Scr and Ccr in patients.Conclusion：TGF-β acts directly on stimulating the synthesis of matrix molecules and myofibroblasts,which is involved in the pathogenesis and evolution of renal scarring.This pathway is probably common to the various glomerular diseases.

关 键 词：转化生长因子-Β1 肌成纤维细胞 肾小球疾病 

分 类 号：R692.6[医药卫生—泌尿科学]