移植肾转化生长因子β1与远期肾功能的关系

TGF-β1 in allograft and long-term renal function

目的 :探讨移植肾内转化生长因子β1(TGF β1)的表达与远期肾功能的关系。方法 :对 16 8例肾功能正常的肾移植患者检测尿TGF β1含量 ,所得相对浓度为 15 1.3～ 5 2 1.7(pg/mg .Cr) ,分别选出浓度最高和最低的各2 0例患者构成A组、B组。检测 2组血TGF β1浓度 ;2组分别有 15例和 12例患者进行了移植肾穿剌活检 ,通过免疫荧光检测活检组织中TGF β1蛋白的表达 ;3年后 ,比较 2组肾功能有无差异 ,对肾功能不全者作移植肾穿剌活检 ,明确移植肾在病理上是否为非特异性损害 (即慢性移植肾肾病的改变 )。结果 :2组患者血TGF β1浓度没有明显差异 ;A组活检显示在肾小管基底膜等处有大量的TGF β1表达 ,其免疫荧光强度为 (10 .5 2± 2 .36 )× 10 6,明显大于B组 [(6 .4 8± 1.5 3)× 10 6];3年后 ,A组肌酐清除率 (Ccr)减少了 (17.6± 6 .9)ml/min、有 7例患者肾功能不全 ,与B组比较有显著差异 (B组分别为 (6 .3± 4 .4 )ml/min和 1例 ) ;肾功能不全的患者 ,移植肾穿剌活检均证实为慢性移植肾肾病。结论 :TGF β1与慢性移植肾肾病的发生有着密切的关联 ;肾移植后检测尿TGF β1对远期肾功能具有预测作用 ;移植肾TGF

Objective To determine the relation between transforming growth factor β1 (TGF-beta1)in allograft and long-term renal function. Methods Urine TGF-β1 relative concentration (divided by urine creatinine) was tested in 168 recipients whose renal function was normal between August 1, 2000 and March 31, 2001. Twenty patients with higher urine TGF-β1 relative concentrations formed Group A,and another 20 patients with lower urine TGF-β1 formed Group B. In both groups biopsies were carried out in 15 cases and 12 cases respectively, and TGF-β1 in the biopsis was tested by immunofluorescence. Blood TGF-β1 concentrations in the 2 groups were also tested. Three years later, the renal function was compared between the 2 groups. Biopsies were carried out in renal recipients whose creatinine was higher than that of the normal. Results Blood TGF-β1 concentrations in the 2 groups were not different significantly; 3 years after the transplantation, there was more loss of renal function and more chronic allograft nephropathy (CAN) cases in Group A than in Group B. Expression of TGF-β1 in the allografts was higher in Group A than in Group B. The differences in the 2 groups were significant.Conclusion The findings suggest that the higher expression of TGF-β1 in the allografts is associated with the lower long-term survival rate of kidney graft. The level of urine TGF-β1 after the renal transplantation can predict the long-term renal function.