移植肾间质纤维化和小管萎缩与肾小管上皮间充质转化的关系

Correlation of interstitial fibrosis and tubular atrophy with tubular epithelial to mesenchymal transition in renal allograft

目的:观察移植肾间质纤维化和小管萎缩病变与肾小管上皮间充质转化的关系。方法:选择38例同种异体肾移植术后9个月的患者,检测肾功能,移植肾行穿刺活检,按照Banff1997慢性评分标准分为2组:第1组和第2组。然后取病理切片进行各项免疫组化检测,观察间质内细胞角蛋白、波形蛋白、α-平滑肌肌动蛋白的表达情况,并行比较分析。结果:第1组有22例患者,第2组有16例。两组的一般临床资料差异无显著性;第2组血肌酐高于第1组,但差异无显著性(P>0.05)。第1组中细胞角蛋白阳性表达率高于第2组;而第2组中波形蛋白、α-平滑肌肌动蛋白表达率高于第1组,差异均有显著性(P<0.05)。结论:在移植肾间质纤维化和小管萎缩过程中,上皮间充质转化与其有明显的相关性;同时出现较高表达的波形蛋白和α-平滑肌肌动蛋白,提示纤维化程度较重。

Objective To observe the correlation of interstitial fibrosis and tubular atrophy with tubular epithelial to mesenchymal transition in renal allograft. Methods A total of 38 patients who had undergone renal allograft for 9 months were selected. Kidney function was measured and allograft biopsy was performed. Then the patients were divided into group A and group B according to the Banff 1997 chronic score criteria. Expressions of cytokeratin, vimentin, and α-SMA were detected by immunohistochemical assay. Results 22 patients were included in group A and 16 patients were in group B. The general clinical data did not differ statistically between the two groups. Blood creatinine level was higher in group B than in group A, but with no significant statistical difference （P 〉 0.05）. The positive rate of cytokeratin expression was higher in group A than in group B, while the positive expression rates of vimentin and α-SMA were higher in group B than in group A, with significant statistical difference （P 〈 0.05 for all comparisons）. Conclusions There is a significant correlation between interstitial fibrosis and tubular atrophy with epithelial to mesenchymal transition in renal allograft. Higher expressions of vimentin and α- SMA suggest the serverity of fibrosis.