单纯性血尿患儿肾小管转化生长因子-β表达的意义

Significance of Expression of Transforming Growth Factor-β in Tubular in Children with Single Hematuria

目的观察单纯性血尿患儿肾组织免疫病理变化及肾小管转化生长因子-β(TGF-β)的表达情况,探讨其在发病机制中的作用。方法选取2004年1月-2007年3月在苏州大学附属儿童医院就诊并行肾活检的32例单纯性血尿患儿,全部患儿行肾活检后,取其部分肾组织行快速冷冻切片,进行常规病理和免疫荧光分析。同时采用免疫组织化学方法检测其肾小管TGF-β表达情况,采用计算机图像分析系统拍摄数字图像。采用Image-Pro Plus 5.02病理图文分析系统,计算各处理组肾小管TGF-β阳性表达率。对照组为1例外伤致肾破裂患儿。结果不同临床类型的单纯性血尿患儿肾组织病理主要表现为系膜增生性改变;少数伴局灶/节段性细胞增生、坏死、纤维化和肾小球硬化(5例,占15.63%)。不同临床类型、不同病理类型的病例均见IgA和(或)IgM沉积,其中系膜区以IgA为主者常伴IgM和(或)IgG沉积。以IgM沉积为主(不伴IgA)者占37.50%,其中仅有IgM者占28.13%;少数伴IgG沉积(3例,占9.38%)。与对照组比较,各单纯性血尿组肾小管TGF-β阳性表达率均显著升高(P<0.05)。不同病理类型之间:弥散性系膜增生(Ⅲb级)患者肾小管TGF-β表达率显著高于Ⅰ级患者,二者比较有显著性差异(P<0.05)。伴Ⅱ级病理改变的Ⅲb级患儿肾小管TGF-β表达率显著高于Ⅰ级和Ⅲb级患儿,其差异有显著性意义(P<0.05)。结论单纯性血尿患儿肾组织主要表现为系膜增生性改变,伴IgA和(或)IgM沉积。提示免疫炎性反应在单纯性血尿发病机制中起重要作用。各组病例肾小管TGF-β表达率均显著增加,提示其在本病的不同病理阶段均发挥重要作用,并可能通过其促纤维化作用引起或加重肾损伤,从而对本病的预后产生重要影响。

Objective To investigate renal immunopathologic changes and the expression of transforming growth factor - β （ TGF - β） in tubular in children with single hematuria,and to explore the role of TGF - β in the pathogenesy of it. Methods Thirty - two children with single hematuria,hospistalized and performed renal biopsy in Children＇s Hospital Affiliated to Soochow University were adopted from Jan. 2004 to Mar. 2007, after biopsy, half of renal tissue was harvested and made into frozen sections, and analysis was followed by routine pathology and immunofluoresceuce. Meanwhile, the expression of TGF - β in tubular was detected by immunohistochemistry, and statistical analysis was followed. The control group was harvested from a child suffered from renal disruption by trauma. Results Children suffered from different clinical types of single hematuria mainly presented mesenterium proliferative changes, few children appeared focal/segmental cell proliferation, necrosis,fibrosis and glomerular sclerosis（5 cases, 15.63% ）. Deposition of IgA and（or） IgM was seen in different clinical and pathological types of cases,of which deposition of mainly IgA in mesenterium area often exists with IgM and（or） IgG. Deposition of mainly IgM （without IgA） covered 37.50% of the total cases, of which 28.13% had only IgM deposit ; few with IgG deposit （ 3 cases,9.38% ）. Contrasting with control group, the expression of TGF -β in tubules of the sufferers in each single hematuria group was increased significantly（ P 〈 0.05 ）. Between different pathological types ： expression of TGF -β in tubular in children with diffused mesenterium proliferation （ grade Ⅲ b） was markedly higher than the children with minor changes（ grade Ⅰ ） ,and the difference was significant（ P 〈0.05 ）. The positive expression rate of TGF -β in tubular in children with focal/segmental changes （ grade Ⅱ ） was increased significantly than grade Ⅰ and grade m b, and the difference was significant （ P 〈 0.05 ）. Conclusions The renal tissue pathology of children with single hematuria mainly represented mesenterium proliferative changes, with deposition of IgA and（or） IgM, suggesting that the immune inflammatory reaction is involved in the pathogenesy of single hematuria. The expression rates of TGF - β in tubular of each group are all higher than that of control group, suggesting that it might play an important role in different pathological phases of the disease,and might cause and exacerbate renal injury by its effect of profibrosis, and ultimately produce critical effect on the prognosis of the disease.