库欣综合征患者RAAS及肾脏组织纤维化因子水平变化分析  

Changes of RAAS and renal fibrosis factors in patients with Cushing.s syndrome

作　　者：刘敏洁[1] 薛现军[1] 王玉路 史瑞芳 候盈苹 苗月亭 王利伟 杨彦磊 李志平 LIU Min-jie;XUE Xian-jun;WANG Yu-lu;SHI Rui-fang;HOU Ying-ping;MIAO Yue-ting;WANG Li-wei;YANG Yan-lei;LI Zhi-ping(Department of Nephrology,Puyang Oilfield General Hospital,Puyang,Henan 457001,China)

机构地区：[1]濮阳市油田总医院肾内科,河南濮阳457001

出　　处：《热带医学杂志》2021年第3期307-310,355,共5页Journal of Tropical Medicine

基　　金：河南省医学科技攻关计划项目(2017082116)。

摘　　要：目的探讨库欣综合征患者肾素-血管紧张素-醛固酮系统(RAAS)变化及肾脏纤维化因子水平。方法选取2015年1月至2020年3月在濮阳市油田总医院治疗的库欣综合征患者101例(观察组),其中非促肾上腺皮质激素(ACTH)依赖性库欣综合征78例,ACTH依赖性库欣综合征23例,同时选取原发性高血压患者50例(对照组),均给予体位试验。同时选取保存的库欣综合征患者肾脏组织42例,正常肾脏组织15例,采用RT-PCR检测纤维化因子:基质金属蛋白酶组织抑制因子-1(TIMP-1)、早期生长反应因子1(EGR1)和基质金属蛋白酶-2(MMP-2)mRNA的表达。结果观察组和对照组立位血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、血浆醛固酮浓度(PAC)和ACTH较卧位升高,差异有统计学意义(P均<0.05);观察组和对照组卧位、立位PRA、AngⅡ、PAC和ACTH比较差异无统计学意义(P>0.05);非ACTH依赖性和ACTH依赖性库欣综合征患者立位PRA、AngⅡ、PAC和ACTH较卧位升高,差异有统计学意义(P均<0.05);非ACTH依赖性库欣患者卧位PAC、卧位和立位ACTH明显低于ACTH依赖性库欣患者,差异有统计学意义(P均<0.05)。库欣综合征患者肾脏组织TIMP-1、EGR1和MMP-2 mRNA相对表达量高于正常肾脏组织,差异有统计学意义(P均<0.05);非ACTH依赖性和ACTH依赖性库欣综合征肾脏组织TIMP-1、EGR1和MMP-2 mRNA相对表达量比较差异无统计学意义(P>0.05)。结论库欣综合征患者体位试验对RAAS无明显影响,其肾脏纤维化因子表达水平明显升高。Objective To investigate the changes of renin-angiotension-aldosterone system(RAAS)and the levels of renal fibrosis factors in patients with Cushing’s syndrome.Methods 101 patients with Cushing’s syndrome(observation group)were selected from Jan 2015 to Mar 2020,including 78 patients with adrenocorticotropic hormone(ACTH)-independent Cushing’s syndrome and 23 patients with ACTH-dependent Cushing’s syndrome,and 50 patients with essential hypertension(control group)were selected for posture test.At the same time,42 preserved kidney tissues of Cushing’s syndrome patients and 15 normal kidney tissues were selected to detect fibrosis factors:tissue inhibitor of metalloproteinase-1(TIMP-1),early growth response factor 1(EGR1)and matrix metalloproteinase-2(MMP-2)by RT-PCR.Results Plasma renin activity(PRA),angiotensinⅡ(AngⅡ),plasma aldosterone concentration(PAG)and ACTH in the observation group and the control group were significantly higher than those in the supine position(P<0.05).There was no statistically significant difference between the observation group and the control group in the lying position,standing position PRA,AngⅡ,PAC and ACTH(P>0.05).In patients with ACTH-independent and ACTH-dependent Cushing’s syndrome,PRA,AngⅡ,PAC,and ACTH in the upright position were significantly higher than those in the supine position(P<0.05).The horizontal PAC,horizontal and vertical ACTH of ACTH-independent Cushing’s syndrome patients were significantly lower than those of ACTHdependent Cushing’s syndrome patients(P<0.05).The relative expressions of TIMP-1,EGR1 and MMP-2 mRNA in the Cushing’s syndrome kidney tissue were significantly higher than those in the normal kidney tissue(P<0.05).There was no significant difference in the relative expression of TIMP-1,EGR1 and MMP-2 mRNA in the renal tissues of ACTHindependent and ACTH-dependent Cushing’s syndrome(P>0.05).Conclusion Posture test has no significant effect on RAAS in patients with Cushing’s syndrome,and the expression level of renal fibrosis

关 键 词：库欣综合征 肾素-血管紧张素-醛固酮系统 体位试验 纤维化因子 

分 类 号：R586.2[医药卫生—内分泌]