霉酚酸酯对IgA肾病患者血清和尿液TGF-β1表达的影响  

Effect of mycophenolate mofetil on expression of serum and urine TGF-β1 in IgA nephropathy

作　　者：关米洁 何永成[2] 李彤[2] 万启军[2] 陈洪滔[2] 

机构地区：[1]汕头大学医学院,广东汕头518037 [2]深圳市第二人民医院肾内科,广东深圳518037

出　　处：《国际泌尿系统杂志》2015年第1期8-13,共6页International Journal of Urology and Nephrology

基　　金：深圳市科创委基础研究项目（编号：20130322000127）

摘　　要：目的 探讨IgA肾病（IgAN）患者血清、尿液TGF-β1表达以及霉酚酸酯（mycophenolate mofetil,MMF）对其表达的影响,揭示MMF治疗IgAN可能的机制.方法 用ELISA法检测健康对照组19例（Ⅰ组）、与MMF组匹配初诊未治疗IgAN 39例（Ⅱ组）、MMF治疗组48例（Ⅲ组）血清、尿液TGF-β1的水平,并比较各组表达差异性.结果 血清中TGF-β1的表达,Ⅱ组较Ⅰ组表达增加（P＜0.05）;Ⅲ组较Ⅱ组表达下降（P ＜0.0001）.尿液中TGF-β1的表达,Ⅱ组、Ⅲ组均较Ⅰ组表达增加（P＜0.05）;Ⅲ组较Ⅱ组表达下降（P＜0.05）.IgAN患者血清TGF-β1的表达与病理级别、尿蛋白排泄呈正相关（P=0.044、0.001）,尿液TGF-β1的表达与GFR呈负相关（P=0.012）,与病理级别、血肌酐、尿蛋白排泄呈正相关（P=0.01、0.013、＜0.0001）.血清TGF-β1与尿液TGF-β1的表达呈正相关（P=0.001）.IgAN LEE分级≤3级与＞3级的患者相比,后者血清、尿液TGF-β1表达增加,差别有统计学意义（P =0.049,0.028）.MMF治疗组疗程3～6个月与≥6个月的患者相比,后者血清、尿液TGF-β1表达下降,差别有统计学意义（P=0.001,0.026）.结论 IgAN患者血清、尿液TGF-β1表达显著增加,并且其表达水平与肾功能进展及严重程度等密切相关,MMF可显著下调IgAN患者血清、尿液中TGF-β1表达.因此,血清、尿液TGF-β1可作为预测IgAN疾病进展及评估MMF疗效的重要指标.Objectives We observed the level of TGF-β1 in serum and urine,and investigated the relationship between MMF and immunoglobulin A nephropathy （IgAN）,to explore the possible mechanisms of MMF to IgAN.Methods The sample was divided into three groups：health control group（Group C）that was composed of 19 healthy volunteers,Group IgAN that was formed by 39 patients without any treatment,and MMF treatment group included 48 patients treated with MMF.The level of TGF-β1 in serum and urine was detected in all sample of three groups by ELISA,the result of which was compared among three groups.Results Comparing with Group IgAN,lower level of TGF-β1 in the serum were found both in Group C and Group MMF（38242.4 ± 18217.9vs29092.5 ±6583.7,23237.2 ± 15107.3 pg/ml,P =0.036,P =0.00047）.Comparing with Group IgAN,lower level of TGF-β1 in urine were found in Group C and Group MMF（77.12 ±48.13vs45.59 ±4.78,58.52 ±32.53 pg/mg Cr,P =0.00000009,P =0.00017）.The level of TGF-β1 in Serum was positively conelated with pathological grading and urinary protein excretion（P =0.044,0.001）.The level of TGF-β1 in urine was negatively correlated with glomerular filtration rate （GFR,P =0.012）and positively correlated pathological grading,serum creatinine,and urinary protein excretion（P =0.01,0.013,0.000039）in IgAN patient.Comparing with the Lee grade ≤ 3,patients with 〉 Lee grade 3 had higher level of TGF-β1 both in serum （P =0.049） and urine（P =0.028）.The patients were grouped according to the Oxford classification score and found that the patients with T ≥ 1 had higher level of TGF-β1 in urine than T =0（P =0.043）.In Group MMF,comparing with the patients who had been treated with MMF less than 6 months,the patients with treatment of MMF more than 6 months exhibited significantly decreased level of TGF-β1 both in serum （P =0.001） and urine （P =0.026）.Conclusions The level of TGF-β1 in serum and urine was significantly elevated in IgAN patients,and its expression is significantly r

关 键 词：肾小球肾炎 IGA 霉酚酸 转化生长因子β1 

分 类 号：R692.31[医药卫生—泌尿科学]