IgA肾病足细胞损伤中的血管内皮生长因子表达及临床意义

Expression of vascular endothelial growth factor in the glomerular podocyte lesion of lgA nephropathy

目的研讨血管内皮生长因子(VEGF)在IgA肾病患者足细胞损伤中的作用及其与IgA肾病临床与病理表现之间的关系。方法 41例经肾穿刺活检明确诊断的IgA肾病患者,采用免疫组织化学技术观察肾组织中足细胞表面特异性标记物WT1及VEGF的分布,并结合临床及肾脏病理进行分析。结果 IgA肾病患者足细胞病变与肾小球内VEGF的表达呈正相关性(r=0.575,P<0.05),随着病变加重,硬化肾小球增加,肾小球内足细胞数目及VEGF的表达均减少(P<0.05),肾小球中的WT1表达与尿蛋白无明显相关性,但与血清肌酐、肾小球硬化呈正相关性(r=0.776,P<0.01,r=0.658,P<0.01)。Ⅰ～Ⅲ级病变组肾小球内VEGF的表达与尿蛋白定量呈正相关(r=0.558,P<0.05),但在IV～V级病变组无相关性;肾小球内VEGF的表达与血压、血清肌酐无显著相关性,但与系膜细胞增殖程度呈正相关(r=0.714,P<0.01),与肾小球硬化呈负相关(r=-0.669,P<0.01)。结论 IgA肾病足细胞损伤中的血管内皮生长因子异常表达在其疾病进展(促进蛋白尿形成及肾小球硬化等)中起重要作用。

[ Objective ] To explore the expression of vascular endothelial growth factor （VEGF） in the glomerular podocyte lesion of lgA nephropathy （IgAN） and their relationship with clinical and pathological manifestations. [Methods ] Forty-one type IgA nephropathy with biopsy-proven IgA nephropathy were used in this study. Immunohistochemistry were applied to detect the expression of anti-WT1, a marker of podoeyte, and vascular endothelial growth factor, in the renal tissue of patients with IgA nephropathy. The relationship of expression pattern of VEGF and elinieopathological manifestation was a/so investigated. [Results] The glomerular podocyte lesion of lgA nephropathy associated with the expression of vascular endothelial growth factor （r =-0.575, P 〈0.05）. The expres- sion of WT1 and VEGF were signifieant decreased in sclerotic glomeruli of patients with IgA nephropathy （P〈O.05）. The expression of WT1 did not correlate with proteinuria, but distinctly associated with the level of sertun ereatinine and glomerulosclerosis （r =0.776, P 〈0.01, r=0.658, P 〈0.01）. From one to three grades, the expression of VEGF with IgA nephropathy associated with proteinuria （r=0.558, P 〈0. 05）, but from four to live grades, it did not associated with proteinuria. The expression of VEGF with IgA nephropathy did not associated with blood pressure and the level of serum creatinine, but it associated with mesangial proliferation （r=0.714, P〈0.01）, and distinctly associated with glomerulosclerosis （r =-0.669, P〈0.01）. [ Conclusions] These results indicate that the abormalexpression of vascular endothelial growth factor in the glomerular podocyte lesion of lgA nephropathy plays an important role in the pathophysiological process of IgA nephropathy, including the increased proteinuria and glomerulosclerosis.