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目的检测IgA肾病中肾小管上皮细胞转分化及小管间质纤维化程度,并探讨其与IgA肾病预后的相关性。方法选取74例IgA肾病患者的肾穿活检组织,分为3组:轻度系膜增生组(27例)、局灶增生组(28例)和增生硬化组(19例)。检测患者的血压、血清肌酐及24h尿蛋白定量。采用免疫组化及Masson方法观察肾小管间质内α-SMA,Vimentin,TGF-β和胶原纤维的表达。结果IgA肾病患者的血压、血清肌酐及24h尿蛋白定量随病理分级增加逐渐升高,增生硬化组患者的各项临床指标均显著高于轻度增生组和局灶增生组(P<0.01),局灶增生组24h尿蛋白定量与轻度增生组间差异有显著性(P<0.01);IgA肾病小管间质α-SMA,Vim-entin及TGF-β表达及表示纤维化程度的胶原纤维表达随分级增加逐渐增高,各组间差异有显著性(P<0.05或P<0.01)。IgA肾病组织中α-SMA,Vimentin及胶原纤维与临床指标血清肌酐、24h尿蛋白定量中度相关(P<0.05),Vimentin与α-SMA、胶原纤维的表达均呈高度相关(P<0.01)。结论IgA肾病中肾小管上皮细胞转分化程度与小管间质纤维化及肾功能异常具有相关性,肾小管上皮细胞转分化可能是肾脏预后不良的关键因素之一,浕-SMA和Vimentin的表达可能作为评估临床IgA肾病预后指标之一。
Objective To detect the renal tubular epithelial cell transdifferentiation and tubulointerstitial fibrosis in IgA nephropathy and to explore its relationship with the prognosis of IgA nephropathy. Methods Thirty-four patients with IgA nephropathy were enrolled in this study. They were divided into three groups: mild mesangial proliferation (n = 27), focal hyperplasia (n = 28) and hyperplastic sclerosis (n = 19). Blood pressure, serum creatinine and urinary protein in 24 h were measured. Immunohistochemistry and Masson’s method were used to observe the expression of α-SMA, Vimentin, TGF-β and collagen fibers in the tubulointerstitium. Results The blood pressure, serum creatinine and urinary protein in patients with IgA nephropathy increased gradually with the increase of pathological grade. The clinical indexes of patients with hyperplasia were significantly higher than those in mild hyperplasia and focal hyperplasia (P <0.01) The expression of α-SMA, Vim-entin and TGF-β in tubulointerstitial of IgA nephropathy and the expression of collagen fiber in fibrosis degree in focal hyperplasia group were significantly different between 24 h urine protein group and mild hyperplasia group (P <0.01) With the gradual increase in grading, the differences between the groups were significant (P <0.05 or P <0.01). The levels of α-SMA, Vimentin and collagen fibers in IgA nephropathy were positively correlated with serum creatinine and 24-hour urine protein (P <0.05), while there was a significant correlation between Vimentin and α-SMA and collagen fibers . Conclusions The degree of renal tubular epithelial cell transdifferentiation in IgA nephropathy is correlated with tubulointerstitial fibrosis and renal dysfunction. Renal tubular epithelial cell transdifferentiation may be one of the key factors in the poor prognosis of kidney, and the expression of 浕-SMA and Vimentin may be As one of the prognostic indicators of clinical IgA nephropathy.