CKD患者尿沉渣中CCN2/CCN3 mRNA检测的临床意义探讨

Investigation of messenger RNA expression of CCN2/CCN3 in the urinary sediments in patients with chronic kidney disease

目的:探讨慢性肾脏疾病(CKD)患者尿沉渣中CCN2(结缔组织生长因子,CTGF)和CCN3(肾母细胞瘤过度表达因子,NOV)mRNA检测及其在监测肾脏损伤中的意义。方法:研究包括35名非糖尿病的CKD患者和12名健康成人。尿沉渣中CCN2/CCN3 mRNA的检测采用Real time-PCR方法。35例CKD患者中17例患者接受了肾活检,这些肾活检组织的肾小球病变程度经PAS染色后评估。结果:CKD患者组尿CCN2/CCN3 mRNA的表达较正常对照组显著升高,而其尿沉渣mRNA的水平与患者的蛋白尿水平并不相关,尿沉渣CCN3mRNA的水平与肾小球病变程度呈负相关。此外,尿沉渣中CCN2/CCN3的比率与肾小球硬化的程度密切相关。结论:尿沉渣中CCN2/CCN3mRNA的比值与CKD患者的肾小球硬化程度密切相关,提示该项检测可能成为非创伤性评估CKD患者肾脏病变程度的有效检查手段。

Objective： To study the messenger RNA （mRNA） expression in urinary sediment emerged as a promising tool to monitor renal damage in patients with chronic kidney diseases （CKDs）. We investigated whether urinary mRNA of connective tissue growth factor （CCN2） and nephroblastoma overexpressed （CCN3）, two molecules involved in the pathogenesis of glomerulosclerosis, has some clinical insights into the management of nondiabetic CKDs. Methods： A total of 35 patients with nondiabetic CKDs were enrolled in our study, as well as 12 healthy controls, mRNA expression of CCN2 and CCN3 were measured by realtime PCR. There were 17 out of those 35 patients who received renal biopsy. Glomerular histological changes were also analyzed on PAS stained slides of those bioosied oatients. Results： Urinary mRNA of both CCN2 and CCN3 were distinctively greater inCKD patients compared to healthy controls. However, urinary mRNA level of neither of those two markers was differently distributed among CKD patients with variable stages of proteinuria. Nevertheless, urinary mRNA of CCN3, but not CCN2 was shown to inversely correlate to the degree of glomerular histological changes. Furthermore, ratio of urinary mRNA of CCN2 to CCN3 had an even stronger correlation efficient with glomerulosclerosis. Conclusion： In summary, our study demonstrates that urinary mRNA of CCN2/3 correlated to the degree of glomerular histological changes in non-diabetic CKDs patients, suggesting that this measurement may be a useful noninvasive tool for evaluating patients with nondiabetic CKDs.