肾病综合征和急性肾炎患儿肾组织PAX2的表达及临床意义

PAX2 Expression of Pathological Kidney in Children with Nephrotic Syndrome and Acute Glomerulonephritis

【目的】通过对儿童肾病综合征及急性肾炎肾组织PAX2表达的对照研究,探讨PAX2在肾脏病理发生中的作用,为肾脏病理损害和慢性进展的发生机制研究提供新思路。【方法】采用免疫组化法观察PAX2在肾活检组织中的表达情况,对儿科28例肾病综合征及18例急性肾炎患儿进行对比研究。【结果】①所有肾病综合征及急性肾炎肾病理切片均存在不同程度PAX2再表达,且其中肾远端小管表达明显高于近端小管(P<0.05),足细胞表达微弱。②PAX2表达密集部位的肾小管多呈现明显扩张或结构不完整表现。③近端小管PAX2表达急性肾炎组较肾病综合征组明显增高(P<0.05),而远端小管表达两组间无明显差异。④按病理类型统计,ECPGN组足细胞无阳性表达,ECPGN组近端小管表达较其他三种病理类型(FSGS、MPGN和MsPGN)明显增高(P<0.05),远端小管各病理类型间无显著性差异(P>0.05)。⑤各病理类型PAX2表达积分与病理积分对比显示,肾小球病理积分高低与足细胞PAX2表达积分无明显关系;肾小管病理积分最低者PAX2表达积分为居中组,而PAX2表达积分较高者病理积分均相对较高。【结论】①儿童肾病综合征和急性肾炎肾组织均存在PAX2胎儿期回归表达。②PAX2再表达部位主要在肾小管,足细胞表达微弱,且与肾脏病理类型有关。③适度表达有利于肾小管再生修复,过表达则导致肾小管损害。

[Objective]To investigate the PAX2 expression in children with nephrotic syndrome （NS） and acute glomerulonephritis （AGN） and try to find the role of PAX2 in the mechanism of these diseases, so as to bring new insight into the study for the mechanism of renal pathogenesis and provide evidence of gene interference to renal disease in the future. [Methods]To investigate the expression of PAX2 in children with NS and AGN by immumohistochemistry. [Results]①PAX2 re-expression was showed in all sections of NS and AGN, more intense staining in distal tubules than in proximal tubules,in podocytes faintly. Normal control was negative. ②Our study showed the tubules more powerfully expressing, presented abnormal structure including dilation and atrophy. ③ The PAX2 expression of proximal tubules in AGN was more intense than in NS （ P〈0.05）, and no difference in distal tubules of all the diseases. ④ECPGN had no PAX2 expression in podocytes, ECPGN showed more intense staining than the FSGS, MPGN and MsPGN in proximal tubules （ P〈0.05）, no significant differences in various types of renal pathology in distal tubules（ P〉0.05）. ⑤Contrast of PAX2 expression integral and pathological integral in various type of renal pathology diplayed that PAX2 expression integral of podocyte was not related with pathological integral of glomerulus and the minimum pathological integral of renal tubule had modest PAX2 expression integral, but the high integral of PAX2 expression presented relatively high pathological integral of renal tubule. [Conclusion]①As long as appearing pathologic change in glomerulus and tubule, there is re-expression of PAX2 in NS and AGN. ②The location of PAX2 is related with pathologic type of renal disease. ③Proper expression of PAX2 may protect renal tissue, overexpression leads to renal damage.