IgA肾病足细胞自噬体的改变及其临床意义  

Change in the number of autophagosomes in podocyte and its clinical significance in Immunoglobulin A nephropathy

作　　者：梁世凯[1] 金娟[1] 龚建光[1] 林波[1] 李一文[1] 何强[1] 

机构地区：[1]浙江省人民医院肾脏病科,浙江杭州310014

出　　处：《中华全科医学》2016年第12期1983-1986,共4页Chinese Journal of General Practice

基　　金：浙江省医学会临床科研基金项目(2013ZYC-A01);浙江省中医药科学研究基金项目(2014ZB002;2015ZA011);浙江省医药卫生一般项目(2014-KYA014;2015KYA025)

摘　　要：目的观察IgA肾病(IgAN)足细胞自噬体的数量变化,初步探讨足细胞自噬与IgAN进展的关系。方法回顾性分析浙江省人民医院2013年1月—2014年12月经肾活检确诊且具有完整临床资料的35例IgAN患者。据病理将患者分为LeeⅡ级、Ⅲ级和Ⅳ级。据尿蛋白分为大量蛋白尿组(尿蛋白≥3.5 g/d)和非大量蛋白尿组(尿蛋白<3.5 g/d)。据eGFR分为2组:eGFR≥60 ml/min和eGFR<60 ml/min组。据性别分为男性组和女性组。光镜和透射电镜分别观察肾脏组织病理学变化以及足细胞结构和自噬体的数量。每5例患者分为一组,每组患者随机选取30个足细胞记录足细胞自噬小体数量,然后计算出每个足细胞内自噬小体的数量。最后分析自噬体数量与病理分期、性别、肌酐清除率和尿蛋白的关系。结果与正常对照组比较,IgAN组患者足细胞自噬体数量明显减少,差异有统计学意义(P<0.001)。然而随着IgA肾病Lees分期级别的增加,足细胞自噬体数量又呈增加趋势。其中LeeⅡ期患者与LeeⅣ期患者相比,差异有统计学意义(P=0.001)。另外,足细胞自噬体数量的减少在女性患者中更为明显,差异有统计学意义(P=0.035)。肾功能较差的患者(男性和LeeⅣ期患者)拥有更多的足细胞自噬体,但差别无统计学意义。自噬体数量在不同尿蛋白组之间的差异无统计学意义。结论足细胞自噬参与着IgA肾病的进展。Objective To observe the number of autophagosomes in podocyte of IgAN, and explore the relationship between autophagy and the progression of renal disease. Methods Clinical data of 35 patients who were diagnosed as IgAN admitted to the Zhejiang Provincial people＇ s Hospital from January,2013 to December, 2014 were retrospectively analyzed. The changes of kidney tissue pathology were detected after HE, PAS and Masson staining by light microscope. The autopbagosomes of podocyte were detected by transmission electron microscopy. Results Compared with the control group, the number of autophagosomes in podocyte of IgAN group were lower, and there was a statistically significance （ P 〈 0. 001 ）. However,with the increase of pathological stage, the decrease in the number of autophagosomes was less obvious. The number of autophagosomes in Lee Ⅳ stage were statistically higher than the Lee Ⅱ than the Lee Ⅱ IgAN group（P = 0.001 ）. Furthemore, there was a statistically bigger number of autophagosomes in female patient than male patients （ P = 0. 035）. Conclusion Podocyte autophagy participates in the progression of IgAN.

关 键 词：自噬 IGA肾病 足细胞 

分 类 号：R692[医药卫生—泌尿科学]