P_(27)、PCNA与IgA肾病中医证型及病理类型的关系

The Relationship Among P_(27),PCNA, Pathological Classification and TCM Syndromes of IgA Nephropathy

目的 :运用免疫组化方法研究原发性IgA肾病患者肾组织中细胞周期调控蛋白P2 7(P2 7)、增殖细胞核抗原PCNA(PCNA)的表达 ,探讨两者与IgA肾病病理分级及其与中医证型之间的关系。 方法 :选择行肾穿刺活检的IgA肾病住院患者 5 2例 ,并按照中医辨证分型标准将其分为肺肾气虚证、脾肾阳虚证、肝肾阴虚证、气阴两虚证、血瘀证、湿热证六型。系膜增生的病理组织学分为 4级。运用免疫组化方法检测P2 7、PCNA的表达。结果 :(1)IgA肾病各个病理分级P2 7、PCNA的表达两两比较有统计学意义。显示随着系膜细胞增生的病理分级程度增高 ,PCNA的表达增高 ,而P2 7的表达则按相反方向进行。病理分级和P2 7、PCNA表达的等级相关性检验 (Spearman法 )显示 :P2 7的表达与病理类型呈非常显著负相关 ,而PCNA的表达与病理类型呈显著正相关。 (2 )IgA肾病三个中医证型的病理分级之间有统计学意义 ,其中气阴两虚证的病理分级比湿热证、肝肾阴虚证高 ,湿热证与肝肾阴虚证的病理分级之间无统计学意义。 (3)随着湿热→肝肾阴虚→气阴两虚的进展 ,P2 7的表达呈现出逐渐减少的趋势 ,而PCNA的表达呈现出逐渐增加的趋势。结论 :(1)P2 7、PCNA作为判断IgA肾病肾脏组织学损伤程度和预后的指标值得深入研究。 (2 )IgA肾病中医证型之间病理分?

Objective:To observe the expression of P 27 and PCNA form paraffin-embedded renal tissue sections of patients with IgA nephropathy and explore the relationship among P 27 , PCNA, pathological classification and TCM syndrome of IgA nephropathy.Methods:Apply renal biopsy to 48 cases of primary IgA nephropathy and the specimen of kidney had been examined with routine pathological method and immunohistochemistry. All the patients with IgA nephropathy in the study were classified into three groups based on TCM syndrome , such as Liver Yin and Kidney Yin Deficiency, both Qi and Yin Deficiency and heat-dampness. The histological score was given according to four grades.Results:(1)The number of PCNA +correlated with histological grade ( r s =0.336, P <0.05).A negative correlation was also found between P 27 + and histological grade( r s =-0.563, P <0.01).(2)The histological grade of both Qi and Yin Deficiency is higher than that of heat-dampness and the Liver Yin and Kidney Yin Deficiency. There was no significant difference between heat-dampness and the Liver Yin and Kidney Yin Deficiency statisticaly.(3)①The level of P 27 in heat-dampness was significantly higher than that in both Qi and Yin Deficiency. ②The level of PCNA in both Qi and Yin Deficiency was significantly higher than that in heat-dampness. ③The level of P 27 in the Liver Yin and Kidney Yin Deficiency was higher than that in both Qi and Yin Deficiency. ④The level of PCNA in Yin and Kidney Yin Deficiency was higher than that in heat-dampness. In a word, the level of P 27 in different TCM syndromes decreased according to the following sequence: heat-dampness, the Liver Yin and Kidney Yin Deficiency, both Qi and Yin Deficiency. On the contrary, the level of PCNA increased in the same sequence.Conclusion:(1)P 27 and PCNA could be useful in grading renal damage histologically and predicating progress of IgA nephropathy. (2)The histological grade of different TCM syndromes was significantly different. The histological grade of both Qi and Yin Deficiency is higher than that of heat-dampness and the Liver Yin and Kiney Yin Deficiency. There was no significant difference between heat-dampness and the Liver Yin and Kidney Yin Deficiency statistialy. (3)Different expression of P 27 and PCNA could indicate the progress of TCM syndromes in IgA nephropathy.