梗阻性肾病肾纤维化与血清中Ⅲ型胶原变化的相关性研究

Relationship between collagen type Ⅲ in serum and renal fibrosis in obstructive nephropathy

目的探讨梗阻性肾病时血清中Ⅲ型前胶原(PCⅢ)及Ⅲ型前胶原氨基末端肽(PⅢNP)浓度的变化与肾组织纤维化的相关性。方法将健康雄性新西兰大白兔40只通过手术分为单侧输尿管部分梗阻组、单侧输尿管完全梗阻组、假手术组、正常对照组,每组10只。术前及术后1～8周抽取大白兔静脉血,放射免疫法测定血清中PCⅢ及PⅢNP含量。术后第8周提取动物肾脏组织,免疫组化SP法染色测定Ⅲ型胶原含量,HE染色测定肾小管肾间质纤维化程度。结果①术后1～8周PCⅢ及PⅢNP值较术前升高(P<0.05)。单侧输尿管部分梗阻组、单侧输尿管完全梗阻组PCⅢ及PⅢNP值较同期对照组、假手术组值升高(P<0.05);②单侧输尿管部分梗阻组、单侧输尿管完全梗阻组肾小管肾间质病变比率较对照组差异有统计学意义(P<0.05);③血清PCⅢ及PⅢNP浓度与病变肾小管肾间质比率呈正相关(P<0.05)。结论血清PCⅢ及PⅢNP与肾积水时肾脏间质纤维化密切相关。在排除其他脏器纤维化的前提下,血清PCⅢ及PⅢNP可以作为早期判断肾积水肾脏纤维化的无创性检查指标。

Objective To explore the relevance of collagen type Ⅲ in serum of obstructive nephropathy and renal fibrosis so as to elucidate the diagnosis value of serum PCⅢ and PⅢNP concentration for renal fibrosis.Methods Forty male New Zealand white rabbits were divided into four groups：the unilateral unilateral complete ureteral obstruction group,the unilateral partial ureteral obstruction group,the sham-operation group and the normal control group.The serum of each rabbit was reserved from the 1st to the 8th week before and after the operation.Collagen type Ⅲ was measured by immunohistochemical staining,and PCⅢ and PⅢNP were measured by radioimmunoassay（RIA）.The kidneys of all rabbits were taken out and stained by HE.Results ①PCⅢ and PⅢNP in serum increased after the operation.②Interstitial fibrosis was observed in the kidneys of rabbits of the unilateral complete ureteral and partial ureteral obstruction groups.③PCⅢand PⅢNP in serum were positively correlated with the degree of glomerulos-clerosis and tubuloinerstial injury.Conclusion PCⅢ and PⅢNP in serum are correlative with renal interstitial fibrosis in hydronephrosis.PCⅢ and PⅢNP in serum can be used to indicate renal fibrosis in hydronephrosis on the condition that other organ fibrosis should be excluded.