【摘要】 目的探讨尿液中转化生长因子β1(TGF-β1)和细胞外基质(ECM)在IgA肾病患者中的变化及其意义。方法将126例IgA肾病患者根据24 h尿蛋白定量和肾小球滤过率(GFR)分为A组(尿蛋白<0.5 g/24 h,GFR>60 mL/min)、B组(尿蛋白0.5~1.0 g/24 h,GFR>60 mL/min)、C组(尿蛋白1.0~3.0 g/24 h,GFR>60mL/min)、D组(尿蛋白>3.0 g/24 h,GFR<60 mL/min或每年下降15%);同时根据病理诊断分为Ⅰ型(轻微损害)、Ⅱ型(微小病变伴少量节段性区域的增殖)、Ⅲ型(局灶性节段性肾小球肾炎,少于50%的肾小球呈现显著变化)、Ⅳ型(弥漫性系膜损害伴有增殖和硬化)、Ⅴ型(弥漫硬化性肾小球肾炎,累及80%以上肾小球)。采用酶联免疫吸附试验(ELISA)分别检测各组患者尿液TGF-β1,采用放射免疫分析法(RIA)检测尿液中的各种ECM,所有检测值均用尿肌酐(Cr)浓度进行校正。结果在不同临床分组中,尿TGF-β1/Cr水平明显高于对照组(P<0.05);除A组外,其他各组患者尿层黏连蛋白(LN)/Cr、Ⅲ型前胶原(PCⅢ)/Cr、Ⅳ型胶原(Ⅳ-C)/Cr水平明显高于对照组(P<0.05),尿透明质酸(HA)/Cr水平明显下降。而在不同的病理分组中,尿TGF-β1/Cr水平高于对照组(P<0.05),尿LN/Cr、PCⅢ/Cr、Ⅳ-C/Cr、HA/Cr自Ⅲ型开始与对照组比较差异有统计学意义(P<0.05)。相关性分析尿TGF-β1/Cr与LN/Cr、PCⅢ/Cr、Ⅳ-C/Cr呈正相关,与HA/Cr无相关性。结论通过尿TGF-β1和ECM在IgA肾病患者中的联合检测,为评价IgA肾病的临床进展和病理改变提供重要的临床依据。更多还原

【Abstract】 Objective To investigate the change and clinical significance of urinary transforming growth factor-beta 1(TGF-β1) and extracellular matrix(ECM) in patients with IgA nephropathy. Methods 126 patients with IgA nephropathy were classified by 24 h urinary protein and glomerular filtration rate(GFR) into Group A(urinary protein<0.5 g/24 h,GFR>60 mL/min),Group B(urinary protein 0.5-1.0 g/24 h,GFR>60 mL/min),Group C(urinary protein 1.0-3.0 g/24 h,GFR>60 mL/min) and Group D(urinary protein>3.0 g/24 h,GFR<60 mL/min or annual 15% decline).According to pathological diagnosis,they were classified into Type Ⅰ(minor damage),Type Ⅱ(minimal change with the proliferation of small segmental area),Type Ⅲ(focal segmental glomerulonephritis,less than 50% of the glomeruli showed significant changes),Type Ⅳ(diffuse mesangial proliferation and sclerosis associated with damage) and Type Ⅴ(diffuse sclerosing glomerulonephritis,involving more than 80% of glomeruli).Enzyme-linked immunosorbent assay(ELISA) was used to measure urinary TGF-β1 level,and radioimmunoassay(RIA) was used to determine urinary ECM level.All data were adjusted by urinary creatinine(Cr).Results In different clinical groups,urinary TGF-β1/Cr levels were higher than those in control group(P<0.05).Laminin(LN)/Cr,precollagen Ⅲ(PCⅢ)/Cr and collagen Ⅳ(Ⅳ-C)/Cr except Group A were significantly higher than those in control group(P<0.05),but urinary hyaluronic acid(HA)/Cr levels in B,C and D groups were lower than those in control group.In different pathological groups,urinary TGF-β1/Cr levels were significantly higher than those in control group(P<0.05).Their levels of urinary LN/Cr,PCⅢ/Cr,Ⅳ-C/Cr and HA/Cr in Type Ⅲ-Ⅴ groups were statistically different with those in control group(P<0.05).Urinary TGF-β1/Cr correlated positively with LN/Cr,PCⅢ/Cr and Ⅳ-C/Cr,but it did not correlated with HA/Cr. Conclusions Combined examination of urinary TGF-β1 and ECM in patients with IgA nephropathy can help to evaluate their clinical progress and pathological changes.更多还原