足细胞标记蛋白及上皮钙黏素在糖尿病肾病中的表达及分析

Expression Analysis of Podocyte Markers Podocalyxin Protein E-cadherin and Cadherin in Diabetic Nephropathy

目的 探讨足细胞标记蛋白（PCX）及E-钙黏素表达与糖尿病肾病患者肾损害的相关性.方法 选取2012年1月至2012年10月期间深圳市人民医院肾内科行肾活检的糖尿病肾病患者100例,同期选择健康体检者20例.对所有受试者的糖化血红蛋白（HbA1c）、24h尿白蛋白排泄率（UAER）、血清肌酐（SCr）、24h尿蛋白量、PCX、上皮钙黏素水平进行检测.根据UAER和SCr水平的不同将100例糖尿病肾病患者分为A、B、C、D4组,其中A组28例,UAER＜ 30 g/24 h,SCr≤135μmol/L;B组30例,UAER 30-299 mg/24 h,SCr≤135μmol/L;C组22例,UAER≥300 mg/24 h,SCr≤135 μmol/L;D组20例,UAER≥300 mg/24h,SCr＞ 135 μmol/L,并以健康体检者为对照组.结果 B组患者病程显著长于A组,C、D两组患者病程显著长于A、B两组（P＜0.05）,C、D两组病程差异无统计学意义（P＞0.05）.A、B、C、D组患者HbA1c水平均显著高于对照组（P＜0.05）,但此四组患者之间差异无统计学意义（P＞0.05）.B、C、D三组SCr均显著高于A组及对照组,且D组显著高于B、C两组（P＜0.05）,而A组与对照组之间以及B、C两组之间差异无统计学意义（P＞0.05）.糖尿病肾病患者UAER水平显著高于对照组,且B、C、D组显著高于A组,C、D组显著高于B组（P＜0.05）,而C、D两组之间差异无统计学意义（P＞0.05）.24 h尿蛋白定量分析,B、C、D组显著高于A组和对照组,且C、D组显著显著高于B组（P＜0.05）,而A组和对照组之间以及C、D组之间差异无统计学意义（P＞0.05）.糖尿病肾病患者PCX、上皮钙黏素水平均显著高于对照组,且B、C、D组显著高于A组,C、D组显著高于B组（P＜0.05）,C、D两组之间差异无统计学意义（P＞0.05）.结论 在UAER和SCr出现异常之前,患者的PCX、上皮钙黏素水平已经发生了改变,且随着肾脏损害程度的加重,这种改变越发显著.PCX、上皮钙黏素表达水平可以在糖尿病肾病早期反映肾脏损害程度,其敏感性优于UAER和SCr.

Objective To discuss the correlation between the expression of podocalyxin（PCX） and E-cadherin and renal damage in patients with diabetic nephropathy.Methods From Shenzhen People＇s Hospital during Jan.2012 and Oct.2012,100 cases of diabetic nephropathy who took renal biopsy were includedin the study,and 20 healthy people for health checkup during the same period were included as well.The glycated hemoglobin （HbA1c）,24 h urinary albumin excretion rate（UAER）,serum creatinine （SCr）,24 h urinary protein,（PCX）,E-cadherin levels of the subjects were detected.Depending on the level of UAER and SCr,the 100 patients with diabetic nephropathy were divided into A,B,C,D four groups,28 cases in group A,UAER ＜30 g/24 h,SCr≤135 μmol/L; 30 cases in group B,UAER （30-299） mg/24 h,SCr≤135 μmol/L; 22 cases in group C,UAER≥300 mg/24 h,SCr≤135 μmol/L; 20 cases in D group,UAER≥300 mg/24 h,SCr ＞ 135 μmol/L.And the healthy people were as the control group.Results The disease duration of group B was significantly longer than group A,of group C,D was significantly longer than group A,B（P ＜ 0.05）,while there was no statistically significant different between group C,D（P ＞ 0.05）.The HbA1 c levels of group A,B,C,D were all significantly higher than the control group（P ＜ 0.05）,while there was no statistically significant difference among the four groups（P ＞ 0.05）.Scr level of group B,C,D were all significantly higher than group A and the control group,and of group D was significantly higher than group B,C（P ＜ 0.05）,while the differences between group A and control group,between group B and C were not statistically significant（P ＞ 0.05）.UAER levels of the patients with diabetic nephropathy were significantly higher than the control group,of group B,C,D were significantly higher than group A,of group C,D were significantly higher than group B（P ＜ 0.05）,while there was no significant difference between group C and D（P ＞ 0.05）.24 h urine protein levels of group B,C,D were significantly higher than group A and control group,of group C,D were significantly higher than group B（P ＜ 0.05）,while the differences between group A and control group,between group C and D were not statistically significant（P ＞ 0.05）.PCX,E-cadherin of the patients with diabetic nephropathy were significantly higher than the control group,of group B,C,D were significantly higher than group A,of group C,D were significantly higher than group B （P ＜ 0.05）,while the difference between group C and D was not statistically significant（P ＞ 0.05）.Conclusion Before the occurrence of abnormal UAER and Scr level,PCX and E-cadherin of the patients change,which get more significant along as the renal injury gets severer.PCX,E-cadherin expression levels can reflect the degree of kidney damage in early diabetic nephropathy,and the sensitivity is better than UAER and SCr.