IgA肾病患者尿足细胞排泄与临床病理相关性分析

The clinical and pathological analysis of urinarythe changes of urinary podocyte in patients with IgA nephropathy

目的观察原发性IgA肾病患者尿足细胞排泄、肾小球足细胞病变，分析其与临床病理之间的关系。方法50例经肾活检明确诊断的IgA肾病患者和10名健康志愿者，利用podocalyxin（PCX）作为标记蛋白，标记尿液和肾组织足细胞，收集患者肾活检时临床资料，各项病理指标和肾组织足细胞PCX荧光表达采用不同的半定量积分法进行评分，电镜检测肾小球外周袢的足突宽度。结果①IgA肾病患者中尿足细胞染色阳性为32例（64％），较健康对照者有统计学差异。②IgA肾病伴尿足细胞阳性患者尿蛋白水平、血肌酐（SCr）、平均动脉压（MAP）较尿足细胞阴性患者增高，血浆白蛋白（Alb）、肾小球滤过率（GFR）降低（P〈0．05）。③光镜示IgA肾病伴尿足细胞阳性患者肾小球硬化程度、新月体发生率较尿足细胞阴性患者明显增高（P〈0．05），但小管间质病变与肾组织足细胞PCX表达阳性指数，2组比较无统计学差异。④电镜结果提示IgA肾病患者尿足细胞阳性足突宽度明显增宽（P〈0．05）。结论足细胞尿是反映肾脏疾病轻重的一个指标，足细胞尿与肾脏病理类型有一定关系，IgA肾病患者尿足细胞排泄指标是否能够独立预测患者的预后还有待证实。

Objective To analyze the urinary podocyte excretion and the glomerular podocyte lesion of the patients with primary IgA nephropathy （IgAN） and their relationships between the clinical and the pathological changes of nephridial tissue. Method Fifty patients with IgAN and ten healthy volunteers were enrolled in this study. To use Podocalyxin （PCX） specific expressed by podocyte cell as a marker protein, mark the podocyte cells collected from the urine and kidney tissue of the IgAN patients, and collect the clinical data of those 50 cases patients with IgAN during carrying out the renal biopsy. Observe the results of pathology. Results （1）In the 50 cases with IgAN,32 eases （64%）were finded urinary podocyte stained positive, which is significant statistically different with healthy people. （2）Patients with IgAN existing urinary podocyte had a high level of urinary protein, creatinine, the mean arterial pressure, and a low level of plasma albumin and glomerular filtration rate （GFR） than those without urinary podocyte. （P〈0. 05）. （3）The results of light microscope shows that the degree of glomerular sclerosis and the incidence rate of crescent observed of the IgAN patients with urinary podoeyte was significantly higher （P〈0. 05） than that of the ones without urinary podoeyte.（4）The result of electron microscope suggests that the positive podocyte foot process of the podocyte collected from IgAN patients become significantly wide. （P〈0. 05）. Conclusion As an indicator reflect the degree of the severity of renal disease, podocyte urine has a certain relationship with the renal pathological types. It is remains to be confirmed whether the urinary podoeyte excretion of IgA nephropathy patients might be an independent indicator of the prognosis of IgA nephropathy patients.