尿转化生长因子-β_1及Ⅳ型胶原与肾内微型癥积的相关性研究

The Correlation of TGF-β_1,ColⅣ with Shenwei Zhengji

目的:通过无创检测方法早期发现肾内微型癥积。方法:对98例肾活检的患者进行中医辨证分型;检测血/尿TGF-β1、尿ColⅣ、Scr、Ccr、24h尿蛋白排泄;对肾组织运用CMIAS计算机病理图像分析系统作半定量测定;观察尿TGF-β1、ColⅣ水平,与肾硬化程度、中医辨证间的相关性。结果:(1)肾病患者尿TGF-β1、ColⅣ明显高于健康人(P<0.01)。(2)尿TGF-β1、ColⅣ与肾小球基质基底膜面密度、肾间质纤维化程度、间质浸润细胞数呈正相关(P<0.05),与尿ColⅣ呈负相关(P<0.05)。随着硬化程度加重尿TGF-β1、ColⅣ水平逐级增高。(3)尿TGF-β1、ColⅣ分别与Scr正相关,与Ccr负相关(P<0.01);与血TGF-β1、24h尿蛋白定量无关。(4)在轻度肾硬化组,Scr和Ccr尚正常时尿TGF-β1、ColⅣ已高于正常组(P<0.01),尿ColⅣ敏感程度要高于尿TGF-β1和Ccr。(5)98例肾脏病患者的中医辨证以脾肾气虚型为主,占66.3%,以传统"四诊"辨为兼瘀血证者仅占8例(8.16%),肾硬化均属于重度,肾功能已减退,尿TGF-β1、ColⅣ水平显著高于无瘀血证者。结论:尿TGF-β1、ColⅣ能早于Scr和Ccr的异常反映肾硬化及硬化程度,不受血TGF-β1和24h尿蛋白定量的影响,可以作为监测肾硬化及其进展的一项无创性早期标志性指标,以尿ColⅣ更为敏感;同时揭示肾微癥积的病因为正虚邪郁,中医传统的宏观辨证加上微观辨证可明显提高辨证的准确性,尿TGF-β1、ColⅣ可以作为中医微观辨证的一项量化指标早期诊断肾内微癥积,监测病情的动态变化,指导早期应用消癥散积中药防治肾硬化。

Objective： To investigate the Urine TGF-β1 and ColⅣ of Patients with SHEN WEI ZHENG JI. Methods： Specimens from renal biopsies of 98 patients by masson staining, with serum/urine level of TGF-β1, urine ColⅣ, serum creatinine, Ccr were examines. Density of matrix membrane, quantity of cell in glomerulus, ratio of interstitial fibrosis and infiltrated cell of interstitial were measured. Senti - quantitative analyses by computer were used to evaluated correlationship among them. Results： （ 1 ） TGF-β1 and ColⅣ in urine of patients were higher than of healthy（P〈0.01 ）. （2）There were positively significant correlation in urine TGF-β1 and ColⅣ with density of matrix membrane, ratio of interstitial fibrosis, infiltrated cell of interstitial （ P 〈 0.05 ）, and negative correlation with urine ColⅣ （P〈 0.05）. （3）There were positively correlation in urine TGF-β1, ColⅣ with serum creati- nine, and negative correlation with Ccr. While no negatively correlation in urine TGF-β1 ColⅣ and serum TGF-β1, urine proteinuria（P〈0.05）. （4）Urine TGF-β1 ,ColⅣ were increased significantly in early glomerulosclerosis. （5）66.3% in patients were featured as Pishenqixu. 8.16% in patients were featured as congestion with higher TGF-β1 and ColⅣ level of in urine. Conclusion： Urine TGF-β1 and ColⅣ measurement can predict glomerulosclerosis without impact of serum TGF-β1 and proteinuria, diagnose early Shenwei Zhengji while ＂Si zhen＂ is delayed to diagnosed, and guide to cure the renal .sclerosis with traditional chinese medicine.