IgA肾病患者尿液转化生长因子β1和细胞外基质的检测及意义  

Significance on the detection of urinary transforming growth factor-beta 1 and extracellular matrix in patients with IgA nephropathy

作　　者：周仁芳[1] 程茂良[1] 曾爱平[1] 李云生[2] 林曦[2] 柯颖杰[2] 吴光华[2] 

机构地区：[1]温州医学院附属温岭医院检验科,浙江台州317500 [2]温州医学院附属温岭医院肾内科,浙江台州317500

出　　处：《检验医学》2010年第10期775-778,共4页Laboratory Medicine

摘　　要：目的探讨尿液中转化生长因子β1（TGF-β1）和细胞外基质（ECM）在IgA肾病患者中的变化及其意义。方法将126例IgA肾病患者根据24 h尿蛋白定量和肾小球滤过率（GFR）分为A组（尿蛋白〈0.5 g/24 h,GFR〉60 mL/min）、B组（尿蛋白0.5~1.0 g/24 h,GFR〉60 mL/min）、C组（尿蛋白1.0~3.0 g/24 h,GFR〉60mL/min）、D组（尿蛋白〉3.0 g/24 h,GFR〈60 mL/min或每年下降15%）;同时根据病理诊断分为Ⅰ型（轻微损害）、Ⅱ型（微小病变伴少量节段性区域的增殖）、Ⅲ型（局灶性节段性肾小球肾炎,少于50%的肾小球呈现显著变化）、Ⅳ型（弥漫性系膜损害伴有增殖和硬化）、Ⅴ型（弥漫硬化性肾小球肾炎,累及80%以上肾小球）。采用酶联免疫吸附试验（ELISA）分别检测各组患者尿液TGF-β1,采用放射免疫分析法（RIA）检测尿液中的各种ECM,所有检测值均用尿肌酐（Cr）浓度进行校正。结果在不同临床分组中,尿TGF-β1/Cr水平明显高于对照组（P〈0.05）;除A组外,其他各组患者尿层黏连蛋白（LN）/Cr、Ⅲ型前胶原（PCⅢ）/Cr、Ⅳ型胶原（Ⅳ-C）/Cr水平明显高于对照组（P〈0.05）,尿透明质酸（HA）/Cr水平明显下降。而在不同的病理分组中,尿TGF-β1/Cr水平高于对照组（P〈0.05）,尿LN/Cr、PCⅢ/Cr、Ⅳ-C/Cr、HA/Cr自Ⅲ型开始与对照组比较差异有统计学意义（P〈0.05）。相关性分析尿TGF-β1/Cr与LN/Cr、PCⅢ/Cr、Ⅳ-C/Cr呈正相关,与HA/Cr无相关性。结论通过尿TGF-β1和ECM在IgA肾病患者中的联合检测,为评价IgA肾病的临床进展和病理改变提供重要的临床依据。Objective To investigate the change and clinical significance of urinary transforming growth factor-beta 1（TGF-β1） and extracellular matrix（ECM） in patients with IgA nephropathy. Methods 126 patients with IgA nephropathy were classified by 24 h urinary protein and glomerular filtration rate（GFR） into Group A（urinary protein0.5 g/24 h,GFR60 mL/min）,Group B（urinary protein 0.5-1.0 g/24 h,GFR60 mL/min）,Group C（urinary protein 1.0-3.0 g/24 h,GFR60 mL/min） and Group D（urinary protein3.0 g/24 h,GFR60 mL/min or annual 15% decline）.According to pathological diagnosis,they were classified into Type Ⅰ（minor damage）,Type Ⅱ（minimal change with the proliferation of small segmental area）,Type Ⅲ（focal segmental glomerulonephritis,less than 50% of the glomeruli showed significant changes）,Type Ⅳ（diffuse mesangial proliferation and sclerosis associated with damage） and Type Ⅴ（diffuse sclerosing glomerulonephritis,involving more than 80% of glomeruli）.Enzyme-linked immunosorbent assay（ELISA） was used to measure urinary TGF-β1 level,and radioimmunoassay（RIA） was used to determine urinary ECM level.All data were adjusted by urinary creatinine（Cr）.Results In different clinical groups,urinary TGF-β1/Cr levels were higher than those in control group（P0.05）.Laminin（LN）/Cr,precollagen Ⅲ（PCⅢ）/Cr and collagen Ⅳ（Ⅳ-C）/Cr except Group A were significantly higher than those in control group（P0.05）,but urinary hyaluronic acid（HA）/Cr levels in B,C and D groups were lower than those in control group.In different pathological groups,urinary TGF-β1/Cr levels were significantly higher than those in control group（P0.05）.Their levels of urinary LN/Cr,PCⅢ/Cr,Ⅳ-C/Cr and HA/Cr in Type Ⅲ-Ⅴ groups were statistically different with those in control group（P0.05）.Urinary TGF-β1/Cr correlated positively with LN/Cr,PCⅢ/Cr and Ⅳ-C/Cr,but it did not correlated with HA/Cr. Conclusions Combined examination of urinary TGF-β1 and ECM in pati

关 键 词：转化生长因子Β1 细胞外基质 IGA肾病 

分 类 号：R446.61[医药卫生—诊断学]