尿畸形红细胞发生机理探讨

MECHANISM OF URINARY ERYTHROCYTE DEFORMITY IN GLOMERULARDISEASES

我们将系列血一尿悬液和血－ＰＢＳ缓冲液悬液分别以０．５ｍｌ／ｍｉｎ的流速泵过微孔直径为３μｍ的Ｐｏｌｙｃａｒｂｏｒａｔｅ滤过膜装置，以研究尿畸形红细胞（ｄＲＢＣ）的形成机理。本研究结果表明，可在体外产生类似于来自活体的ｄＲＢＣ；肾小球滤过膜对红细胞（ＲＢＣ）的机械性损伤、尿液ｐＨ和渗透压以及尿液的某些成分，都是ｄＲＢＣ形成的必要因素；各种形态ｄＲＢＣ的发生，与特定的ｐＨ和渗透压环境有关。

e developed an in vitro model to produce urinary dysmorphic RBCs and to investigate the influ-ence of pH and osmolality. The pH and osmolality of the RBCs suspension was made to change sys-tematically within a range of pH 5 -8 and 200-800 mOsm / kg, and at a flow rate of 0,5ml / minthrough a polycarbonate filter(Calif, USA) with pore diameter of 3μ. Then the samples were examinedwith phase-contrast microscopy. Our data showed that:(1) The fornlation of glomerular RBCs dependson their passage through a narrow pore and the presence of certain suspension, which is also present inglomerulonephritis. Suspension of RBCs in urine with the same osmolality and pH, but withoutfiltration did not produce glomerular shapes.(2)Urine facilitated the production of glomerular shapes.Filtration of RBCs suspension in physiological buffer instead of urine produce less dysmorphic shapesthan filtration in urine of various pH and osmolality.(3) Certain types of urinary RBCs shapes occur- ring predominantly at specific conditions of pH and osmolality( < 400 mOsm / kg) producedglomerular shapes most frequently, e . g.doughnut-like RBCs were Droduced by urine with DH 7.Ourdata suggested that the mechanism of glomerular RBCs formation might result from the passage ofRBCs through narrow defects in the ruptured glomerular capilary wall and a chemical injury to theRBCs in the tubular lumen induced by urinary constituents.