肾病综合征患者尿足细胞与临床病理关系的分析

Relationship between urinary podocyte and clinicopathological features in patients with nephrotic syndrome

目的通过观察肾病综合征(NS)患者尿足细胞与临床病理关系,探讨尿足细胞检测代替肾活检的可能性。方法选取80例NS患者被肾穿前1 d的晨尿和20例正常对照的晨尿各100 ml,离心涂片。用抗人足细胞标记蛋白Podocalyxin(PCX)单克隆抗体分别对尿沉渣涂片和肾组织切片进行免疫组化及免疫荧光检测,并于光学显微镜下计数尿足细胞数目及肾小球足细胞密度,比较NS各种类型尿足细胞排泄情况与肾脏临床病理的相关性;同时收集患者的临床一般资料和实验室资料,并分析其与尿足细胞和肾组织足细胞的关系。结果各组间年龄、性别构成及临床生化指标比较差异均无统计学意义(P>0.05)。正常对照组免疫组化及免疫荧光检测尿未见足细胞,免疫组化及免疫荧光检测肾组织PCX,可见大量足细胞;NS不同类型组与正常对照组尿足细胞及肾小球足细胞密度相比有统计学差异(P>0.05);各类型组中,以局灶节段性肾小球硬化(FSGS)组患者尿中检出的足细胞数最多,其次是系膜增生性肾小球肾炎(MsPGN)组,再次是膜性肾病(MN)、微小病变性肾病(MCD)。各组患者尿足细胞数与24 h尿蛋白量及肾小球病理积分呈正相关(P<0.05),与血浆白蛋白、肾小球肾足细胞密度呈负相关(P<0.05),与血肌酐无相关性(P>0.05);各组患者肾小球足细胞密度与24 h尿蛋白量及尿足细胞呈负相关(P<0.05),与血浆白蛋白及肾小球病理积分呈正相关(P<0.05),与血肌酐无相关(P>0.05)。结论尿足细胞的检测是一项可反映肾病综合征不同病理类型病情轻重的无创性指标;尿足细胞数有可能作为反应肾脏病变进展的重要指标。

Objective To explore the possibility of urinary podocyte test instead of renal biopsy by observing the relationship between urinary podoeyte and clinical pathological features in patients with nephrotic syndrome（NS）. Methods The morning urine of 100 ml was collected from 80 NS patients before the renal biopsy and 20 healthy controls. The anti-human PCX monoclonal antibody was used to detect the number of urinary podocyte and the density of glomerular podocytes by immunofluorescence and immunohistocbemistry under the microscope. The correlation of urinary podocyte with clinical pathology of kidney was analyzed in NS patients. The general clinical data and laboratory data of patients ware collected, and their relationships with urinary podocyte and glomerular podocytes were analyzed. Results There was no statistically significant difference in age, gender and biochemical indices among different NS groups （P 〉 0.05 ）. No podocytes were found in urine of healthy controls, but a lot of podocytes were detected in kidney tissues. There was statistically significant difference in the number of urinary podocytes and the density of glomerular podocytes between nephrotie syndrome group and healthy con-trol group, and the number of urinary podocyte was the most in patients with focal segmental glomerulosclerosis（ FSGS）, followed by me-sangial proliferative glomerulonephritis（ MsPGN）, membranous nephropathy（MN） ,and minimal change disease（MCD）. The number of u-rinary podocyte in NS group was positively correlated with 24 h urinary protein quantity and glomerular pathological scores （ P 〈 0. 05 ）, negatively correlated with serum albumin and glomerular PCX expression quantity （P 〈 0.05 ）, but was not correlated with serum creatinine （ P 〉 0.05 ）. The number of glomerular PCX in NS group was negatively correlated with 24 h urinary protein quantity and urinary podocyte （ P 〈 0.05 ）, positively correlated with serum albumin and glomerular pathological scores （ P 〈0.05 ）, but not to serum creatinine （ P 〉 0. 05 ）. Conclusion The urinary podocyte is a non-invasive indicator to diagnose different path ological types of the nephrotic syndrome, and the number of urinary podocytes could be an important indicator to reflect the progress of kidney disease.