乙型肝炎病毒相关性膜性肾病中nephrin的表达及意义  

The expression and significance of nephrin in hepatitis B virus-associated membranous nephropathy

作　　者：庄永泽[1] 魏丽芳[1] 余英豪[2] 曾玲[2] 熊喜生[2] 吴在增[2] 

机构地区：[1]南京军区福州总医院福建医科大学福总临床医学院肾脏病科,福州350025 [2]南京军区福州总医院福建医科大学福总临床医学院病理科,福州350025

出　　处：《中华内科杂志》2011年第9期766-770,共5页Chinese Journal of Internal Medicine

基　　金：基金项目：福建省科技计划重点项目（2007Y0030）

摘　　要：目的观察nephrin在HBV相关性膜性肾病（HBV—MN）中的表达特点，研究HBV．MN中足细胞的损伤程度及意义。方法采用免疫组化方法检测35例HBV—MN患者肾组织nephrin的表达情况，并进行半定量评分，分析其与临床病理指标的相关性。结果35例HBV—MN患者中I期6例、Ⅱ期20例和Ⅲ期9例。正常肾组织nephrin于肾小球上皮侧呈线性高强度表达，HBV—MN患者肾组织nephrin表达显著减少，在HBV—MN的不同分期中nephrin表达无显著性差异（P〉0．05），但肾病综合征组nephrin的表达明显低于非肾病综合征组患者（P〈0．01），且不同程度尿蛋白患者其表达也有显著性差异（P〈0．05）。Spearman相关分析显示肾组织nephrin与24h尿蛋白定量之间存在负相关（r=-0．378，P〈0．05）。Ⅱ期患者呈肾病综合征者nephrin的表达也明显低于非肾病综合征患者（P〈0．01）。结论HBV-MN早期足细胞即受损伤，肾组织nephrin表达明显下调，尤其在肾病综合征患者更明显，HBV—MN中nephrin表达下调与蛋白尿的产生密切相关。Objective To observe the expression of nephrin in hepatitis B virus-associated membranous nephropathy （HBV-MN） , and investigate the impairment and significance of podocyte in HBV- MN. Methods The protein expression of nephrin in renal biopsy specimens in 35 patients, who were diagnosed as HBV-MN by renal biopsy, was determined by immunohistochemistry and tested by semiquantitative method. The relationship between the expression of nephrin and clinicopathological data was analyzed. Results Among the 35 cases with HBV-MN, 6 were in MN phase Ⅰ , 20 in MN phase Ⅱ and 9 in MN phase Ⅲ. A strong intensity expression of nephrin in normal glomerulus was found along capillary loop of glomerulus, while its expression in HBV-MN patients decreased obviously. There was no significantly difference in the expression of nephrin among the different stages of HBV-MN（P 〉 0. 05 ）. The expression of nephrin in different clinical types was significantly different （ P 〈 0. 05 ） . The expression of nephrin in patients with nephrotic syndrome was significantly lower than that in patients without nephrotic syndrome （P 〈 0. 01 ）. The expression of nephrin in different grades of 24-hour urinary protein excretion quantity was significantly different （ P 〈 0. 05 ）. There was negative co,relation between the expression of nephrin and 24-hour urinary protein excretion quantity（ r = - 0. 378 ,P 〈 0. 05 ）. In the patients with HBV-MN phase Ⅱ , the expression of nephrin in patients with nephrotic syndrome was also significantly lower than that in patients without nephrotic syndrome （P 〈 0. 01 ）. Conclusions The damage of podocytes emerge in the early stage of HBV-MN and the expression of nephrin in HBV-MN patients, especially in patients with nephrotic syndrome, are significantly down regulated. The descended expression of nephrin in HBV-MN patients may promote the production of proteinuria.

关 键 词：肝炎病毒 乙型 肾小球肾炎 膜性 病理学 NEPHRIN 免疫组织化学 

分 类 号：R51[医药卫生—内科学] R692[医药卫生—临床医学]