【摘要】 目的 肾脏纤维化是慢性肾脏病(chronic kidney disease,CKD)进展的主要病理过程,本研究探讨CKD1~2期患者血清及尿液Ⅳ型胶原、层黏连蛋白水平的变化与早期CKD患者肾脏纤维化的关系。方法 以63例住院接受肾穿刺活检、但未接受糖皮质激素、免疫抑制剂、血管紧张素转化酶抑制剂、血管紧张素Ⅱ受体拮抗剂和中草药等治疗的的CKD1~2期患者为研究对象(CKD组),并根据肾活检病理结果分为肾小球硬化组、肾间质纤维化组和无纤维化组3个亚组。肾活检当日留取血及尿标本。血清及尿液Ⅳ型胶原、层黏连蛋白采用酶联免疫吸附法测定。肾组织Ⅳ型胶原、层黏连蛋白表达强度利用病理图像分析软件对免疫组化阳性目标进行光密度测定。结果 早期CKD患者血清及尿液中Ⅳ型胶原、层黏连蛋白水平均高于健康人群。肾小球硬化组、肾间质纤维化组和无纤维化组3个亚组之间血清Ⅳ型胶原、层黏连蛋白水平相比无统计学差异,尿液中Ⅳ型胶原、层黏连蛋白水平相比有统计学差异。24 h尿蛋白定量、尿β2-微球蛋白及尿N-乙酰-β-D-氨基葡萄糖苷酶和eGFR与肾组织Ⅳ胶原水平及层黏连蛋白的表达强度无关。血清Ⅳ胶原水平、层黏连蛋白与肾组织Ⅳ胶原水平、层黏连蛋白的表达强度无关,相反尿液Ⅳ胶原水平、层黏连蛋白与肾组织Ⅳ胶原水平及层黏连蛋白的表达强度存在正相关。结论 尿液Ⅳ型胶原、层黏连蛋白水平能够反映肾脏细胞外基质的变化,同时检测尿Ⅳ型胶原、层黏连蛋白水平有望成为判断早期CKD患者肾脏纤维化发生的指标。更多还原

【Abstract】 Objective To analyze the change of serum and urine type Ⅳ collage and laminin,and their correlation with renal fibrosis in patients with early chronic kidney disease(CKD).Methods Sixty-three cases of CKD with stage 1 to 2 were divided into glomerulosclerosis group,renal interstitial fibrosis group and no fibrosis group according to the renal pathological changes.Twenty-five healthy volunteers served as the control group.Enzyme-linked immunosorbent assay(ELISA)was applied to detect the serum and urine levels of type Ⅳ collage and laminin.The absorbance(A)values of type Ⅳ collage and laminin in the renal tissue were measured by pathological imaging analysis software.Results Serum and urine type Ⅳ collage and laminin levels in early CKD patients were significantly higher than those in normal controls.Serum type Ⅳ collage and laminin levels showed no significant difference among glomerulosclerosis group,renal interstitial fibrosis group,and no fibrosis group(P>0.05),but urine type Ⅳ collage and laminin levels had significant difference among groups of glomerulosclerosis,renal interstitial fibrosis,and no fibrosis(P<0.05).There was significantly positive correlation between the level of urine type Ⅳ collage and A value of type Ⅳ collage in the renal tissue(r =0.66,P<0.05),and between the level of urine laminin and A value of laminin in the renal tissue(r=0.73,P<0.05).There was no positive correlation between the level of serum type Ⅳ collage and A value of type Ⅳ collage in the renal tissue(P>0.05),and between the level of serum laminin and A value of laminin in the renal tissue(P>0.05).Conclusions Levels of urine type Ⅳcollage and laminin could reflect the change of the extracellular matrix in the kidney.Renal fibrosis can be judged by determination of urine type Ⅳ collage and laminin in early CKD patients.更多还原