系膜增生性肾小球肾炎患者血小板反应蛋白-1的检测及其临床意义

EXPRESSION AND SIGNIFICANCE OF THROMBOSPONDIN-1 (TSP-1) IN THE PATHOGENESIS OF MESANGIAL PROLIFERATIVE GLOMERULONEPHRITIS

目的探讨血小板反应蛋白-1(Thrombospondin-1,TSP-1)在人类系膜增生性肾小球肾炎(MsPGN)中的蛋白表达及其在发病中的作用。方法采用HE、PAS、PASM及免疫组织化学SABC染色法对56例系膜增生性肾小球肾炎(mesangial proliferative glomerulonephritis,MsPGN)肾活检组织进行观察,并经计算机医学图像分析系统进行分析。结果参照1982年WHO关于肾小球病理学分类标准,分为轻、中、重度三组,重度系膜组织增生组24h尿蛋白定量、白蛋白、甘油三酯、总胆固醇均较轻、中度系膜组织增生组明显升高(P均<0.05);三组内生肌酐清除率无明显差别;有肾间质病变内生肌酐清除率(CCr)为(91.13±42.52)ml/min,无肾间质病变CCr为(122.82±36.59)ml/min差异有统计学意义(P<0.05),24h尿蛋白定量、尿α-1微球蛋白差异也有统计学意义(P<0.05)。在各组MsPGN切片中TSP-1均有阳性表达,阳性反应主要分布在肾小球系膜区、部分毛细血管襻及肾小管上皮细胞胞浆,随增生程度明显增加(P<0.05)。在无明显病变的肾间质中未见TSP-1表达,随着病变程度加重,TSP-1的表达量显著增加,在炎症浸润及纤维化显著的间质区亦可见表达增强(P<0.01)。光镜观察是否存在肾小球袢内微血栓,MsPGN伴肾小球毛细血管袢内微血栓(MsPGN+T)组TSP-1蛋白表达明显增强(P<0.05)。结论 MsPGN时病理改变和临床指标24h尿蛋白定量、白蛋白、甘油三酯、总胆固醇、CCr有一定关系,TSP-1蛋白在肾小球与肾小管表达均显著增高,病理改变有血栓时则更明显,提示该因子在MsPGN发病中有一定的作用。

Objective To elucidate the association of renal expression of Thrombospondin- I（TSP- 1） with renal disease in the patients with mesangial proliferative glomerulonephritis（MsPGN） and to evaluate the role of and TSP- 1 in the genesis of MsPGN. Methods Histotopathological （HE, PAS, PASM） anal- ysis and immunohistochemistry were employed to evaluate the change and the expression of TSP- 1 in the tissues of kidney and computer image analysis system in 56 patients with MsPGN. According to the score of the renal pathology injury, patients were divided into three groupsz light injury group, middle injury group, severe injury group. Results The density of proteinuria quantitative, serum cholesterol, albumin and triglyceride in severe injury group were higher statistically significant difference than the light injury and middle injury groups （P〈0. 05）. Ccr in three groups had no significant difference, but the Ccr was higher in MsPGN without renal tubulointerstitial pathological injury group （P〈0. 05）. TSP- 1 was detec- ted in glumeruli and tubulointerstitial with MsPGN and also revealed a relationship between the increased expression and severity of the lesions. MsPGN, and the expression increased gradually with the dgree of renal mesangial and interstitial pathological injury between the severe injury group and light injury, middle injury groups （P〈0.05）, as well as, the expression was higher in the presence of glomerular microthrom- bus group （P〈0.05）. Conclusion There are a certain correlation between the pathological injury and cKn- ical manifestation in MsPGN. Increased expression of TSP- 1may plays an important role in the pathologi- cal accumulation of extracellular matrix and renal interstitial pathological injury in MsPGN.