肾实质细胞早衰与IgA肾病进展病机的关系研究  

Clinical Study on Relationship of Renal Parenchymal Cell Premature Senescence and Pathogenesis in IgA Nephropathy

作　　者：陈客宏 胡威 陈佳 林利容 汪晓月 何娅妮 CHEN Kehong;HU Wei;CHEN Jia(Department of Nephrology,Daping Hospital,Research Institute of Surgery,Army Medical University,Chongqing ,400042)

机构地区：[1]陆军军医大学第三附属医院(野战外科研究所)肾内科

出　　处：《中国中西医结合肾病杂志》2019年第4期298-301,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：科技部支撑计划项目(No.2015BAI12B06);国家自然科学基金资助项目(No.81770731,81670661,81400733)

摘　　要：目的:本研究拟探讨肾实质细胞早衰与IgA肾病气虚、阴虚向阴阳两虚证候演变的关系。方法:纳入2016年01月~2017年06月151例已行肾活检的IgA肾病患者,根据《IgA肾病中医证候流行病学临床调查表》进行中医辨证,分析各证型患者临床和实验室指标,以及肾实质细胞衰老之间的关系。采用牛津病理分型评分分析肾组织病理损伤。利用免疫组化检测肾实质细胞衰老标志物P16和DcR2的表达。Spearson相关分析IgA肾病患者肾实质细胞早衰与中医证型之间关系。结果:151例IgAN患者脾肾气虚证患者比例最高,为51例(33.8%);气阴两虚证患者为48例(31.8%);肝肾阴虚证为30例(19.9%);脾肾阳虚证为22例(14.6%)。脾肾气虚证、气阴两虚证、肝肾阴虚证、脾肾阳虚证牛津病理分型评分依次升高,分别为(4.2±3.3)、(5.4±3.6)、(8.2±4.2)、(12.4±3.2)。脾肾气虚证、气阴两虚证、肝肾阴虚证、脾肾阳虚证P16肾小球阳性细胞比例依次升高,脾肾气虚证(42.1±4.6)%明显低于脾肾阳虚证(57.2±5.1%,P<0.05)。这四种证型患者P16阳性肾小管细胞比例也依次升高,脾肾气虚证(25.1±7.6)%、气阴两虚证(35.4±11.2)%、肝肾阴虚症(53.8±10.6)%明显低于脾肾阳虚证(85.1±13.1)%(P<0.05)。脾肾气虚证、气阴两虚证、肝肾阴虚证、脾肾阳虚证DcR2阳性肾小管细胞比例依次升高,分别为(25.1±7.6)%、(35.4±11.2)%、(53.8±10.6)%、(85.1±13.1)%,组间差异有统计学意义(P<0.05)。P16、DcR2阳性肾实质细胞比例分别与IgA肾病中医证型差异有统计学意义(P<0.05)。结论:肾实质细胞早衰可能是IgA肾病气虚、阴虚向阴阳两虚证候演变的重要细胞学基础。Objective:To investigate the relationship between renal parenchymal cell premature senescence and traditional Chinese medicine(TCM)pathogenesis in IgA nephropathy.Methods:151 patients with IgA nephropathy who had been performed renal biopsy were included from January 2016 to June 2017.According to the clinical manifestations of the patients,TCM syndrome differentiation was identified.The expression of P16 and DcR2 in renal tubular cells was detected by immunohistochemistry.The relationship between renal parenchymal cell premature failure and TCM syndrome in IgA nephropathy patients was analyzed.Results:There were 51 cases(33.8%)with Pishenqixu syndrome,48 patients(31.8%)with Qiyinliangxu,30 cases(19.9%)with Ganshenyinxu in 151 IgAN patients.According to Oxford pathological classification score,the renal tissue injury of Pishenqixu,Qiyinliangxu,Ganshenyinxu and Pishenyangxu was gradually serious.The proportion of P16 positive cells in glomeruli of patients with Pishenyangxu was(57.2±5.1)%.It was significantly higher than that in the patients with Pishenqixu syndrome(42.1±4.6%,P<0.05).The ratio of P16 positive tubule cells in the same Pishenyangxu syndrome was 85.1±13.1%,significantly higher than that in Ganshenyinxu syndrome(53.8±10.6%),Qiyinliangxu syndrome(35.4±11.22%)and Pishenqixu syndrome(25.1±7.6%).The results of Spearson correlation analysis showed that the proportion of P16 positive cells in glomerulus and renal tubule cells were significantly related to the TCM syndrome type of Shenqixushuai(P<0.05).The proportion of DcR2 positive cells was the highest in kidney of patients with Pishenyangxu(85.1±13.1%).The patients with Ganshenyinxu and Qiyinliangxu were 53.8±10.6 and 35.4±11.2,respectively.The proportion of DcR2 positive cells in Pishenqixu syndrome was the lowest(25.1±7.6%).Spearson correlation analysis showed that the proportion of DcR2 positive cells in renal cells was significantly correlated with TCM syndrome type(P<0.05).Conclusion:Premature senescence of renal parenchymal cells may be t

关 键 词：细胞早衰 肾气虚衰 IGA肾病 中医证型 

分 类 号：R277.5[医药卫生—中医学]