结缔组织生长因子在肾活检组织中的表达及意义

The Expression of Connective Tissue Growth Factor in Human Renal Biopsy Specimens

目的 :检测不同间质纤维化程度的肾活检组织中结缔组织生长因子 (CTGF)和α -平滑肌肌动蛋白(α -SMA)的表达 ,观察CTGF、α -SMA与肾间质纤维化程度和肾功能之间的关系 ,探讨CTGF在肾脏肌成纤维细胞形成中可能的作用。方法 :选取不同病因和类型的肾活检标本 4 5例 ,按常规进行染色 ,根据光镜下小管间质的病变分组。采用免疫组化方法 ,检测各组标本CTGF和α -SMA的表达 ,并将CTGF的表达、α -SMA的表达、间质纤维化程度和患者血肌酐水平进行比较。结果 :CTGF主要表达于肾小管上皮细胞和一些肾间质细胞胞浆 ,并且随间质病变的加重 ,表达量增加 ,范围增大 ;α-SMA在病变肾间质区域表达增强 ,一些管腔破坏和萎缩的肾小管上皮细胞也可见表达 ,阳性分布区域与CTGF相似。肾小管间质中CTGF、α -SMA表达量之间呈正相关 ,CTGF和α -SMA表达量与肾间质纤维化病变程度和患者血肌酐水平均呈正相关关系。结论 :CTGF可能通过促进间质中肌成纤维细胞的形成而参与肾间质纤维化的形成 。

Objective:To detect the expression of connective tissue growth factor (CTGF) and α-smooth muscle actin(α-SMA) in human renal biopsy with different degree of tubulointerstitial lesions and to study the correlation among CTGF,α-SMA,the degree of tubulointerstitial fibrosis and renal function.Methods:Fouty-five specimens were obtained by percutaneous renal biopsy from patients with various renal diseases. According to tubulointerstitial injury under light microscopy, specimens were classcified into four groups.CTGF and α-SMA expression were detected by immunohistochemistry.Results:The expression of CTGF was generally indistinguishable in tissues without injury, obvious positive on tubular epithelial cells and interstitial cells in chronic damaged tissues, which was highly significant correlated with the extent of tubulointerstitial fibrosis and serum creatinine. The expression of α-SMA was scanty in un-injured interstitial cells except vascular smooth muscle cells, but it was strongly up-regulated in damaged interstitial and tubular epithelial cells, with a distribution similar to that of CTGF staining; The expression of α-SMA was significantly correlated with the extent of tubulointerstitial fibrosis and serum creatinine. The correlation between the expression of CTGF and α-SMA was highly significant.Conclusion:CTGF may involved in tubulointerstitial fibrosis through myofibroblasts and up-regulation of CTGF may be prognostic in renal diseases.