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目的:观察肾功能正常的慢性肾炎患者的血、尿Ⅳ型胶原(Col-Ⅳ)及层黏蛋白(LN)含量的变化与肾脏病理改变的关系及临床应用价值。方法:(1)采用双抗体夹心酶联免疫吸附(ELISA)法测定67例肾功能正常的慢性肾炎患者和20例健康人的血、尿Col-Ⅳ与LN含量。(2)慢性肾炎患者均接受肾活检病理检查。观察以上指标与肾脏病理改变的关系。结果:(1)与健康人相比,慢性肾炎组患者血、尿Col-Ⅳ及LN水平均明显增高(P<0.05)。(2)系膜细胞增生Ⅲ级组、Ⅳ级组与健康人组比较,血、尿Col-Ⅳ及LN均明显增高(P<0.05)。系膜细胞增生程度与血Col-Ⅳ水平关系最密切(P<0.05)。(3)各系膜基质增生组与健康组比较,血、尿Col-Ⅳ及LN均显著增高(P<0.05)。系膜基质增生程度与尿Col-Ⅳ水平关系最为密切(P<0.05)。(4)肾小球球性硬化10%～25%组与健康人比较,血、尿Col-Ⅳ及LN均明显增高(P<0.05)。硬化率与血LN关系最密切(P<0.05)。(5)间质纤维化程度与尿Col-Ⅳ水平关系最密切(P<0.01)。(6)小管萎缩≤10%者较健康者,尿Col-Ⅳ、LN均显著增高(P<0.01)。小管萎缩>5%者较健康者,血Col-Ⅳ明显增高(P<0.01)。小管萎缩>10%者尿Col-Ⅳ则明显降低(P<0.05)。(7)血Col-Ⅳ水平与血LN水平正相关(P<0.01)。尿Col-Ⅳ水平与尿LN水平正相关(P<0.01)。但血、尿Col-Ⅳ水平之间及血、尿LN水平之间均无线性相关关系。结论:(1)肾功能正常的慢性肾炎患者血、尿Col-Ⅳ与LN水平显著高于健康人群。(2)血与尿Col-Ⅳ、LN水平的变化可在一定程度上反映肾脏病理的改变,与系膜细胞基质的增生程度、间质纤维化、肾小球球性硬化有一定的关系。但血Col-Ⅳ、LN水平主要反映了Col-Ⅳ、LN代谢的活跃,与系膜细胞增生关系更为密切;而尿Col-Ⅳ、LN水平则与基质增生、间质纤维化关系更为密切。它们之间均存在着相关关系。因此监测血与尿Col-Ⅳ、LN的动态变化,综合判断,对于监测肾脏纤维化倾向有一定价值。
Objective: To observe the relationship between the changes of serum and urinary type Ⅳ collagen (Col-Ⅳ) and laminin (LN) and the pathological changes of kidney and its clinical value in patients with chronic nephritis with normal renal function. Methods: (1) Serum and urinary levels of Col-Ⅳ and LN were measured in 67 cases of chronic nephritis patients and 20 healthy people with double antibody sandwich enzyme-linked immunosorbent assay (ELISA). (2) Patients with chronic nephritis were subjected to renal biopsy. Observe the above indexes and the relationship between renal pathological changes. Results: (1) Compared with healthy controls, the serum levels of Col-Ⅳ and LN in patients with chronic nephritis were significantly increased (P <0.05). (2) Compared with healthy group, the levels of Col-Ⅳ and LN in blood were significantly increased in grade Ⅲ and Ⅳ of mesangial cell proliferation (P <0.05). The mesangial cell proliferation was most closely related to the blood Col-Ⅳ level (P <0.05). (3) Compared with healthy group, Col-Ⅳ and LN of blood and urine were significantly increased in each mesangial matrix hyperplasia group (P <0.05). The mesangial matrix hyperplasia and urinary Col-Ⅳ levels were the most closely related (P <0.05). (4) The levels of Col-Ⅳ and LN in blood and urine of 10% ~ 25% patients with glomerular sclerosis were significantly higher than those of healthy people (P <0.05). Sclerotic rate and blood LN most closely (P <0.05). (5) The degree of interstitial fibrosis was most closely related to urinary Col-Ⅳ (P <0.01). (6) Urine Col-Ⅳ, LN were significantly increased (P <0.01) in patients with tubule atrophy ≤10%. Tubal atrophy> 5% of those who were healthy, blood Col-IV was significantly higher (P <0.01). Tubal atrophy> 10% urine Col-Ⅳ was significantly lower (P <0.05). (7) There was a positive correlation between serum Col-Ⅳ level and blood LN level (P <0.01). Urine Col-Ⅳ level was positively correlated with urinary LN level (P <0.01). However, there was no linear correlation between blood and urinary Col-IV levels and blood and urine LN levels. Conclusion: (1) The levels of Col-Ⅳ and LN in blood and urine of patients with chronic nephritis with normal renal function are significantly higher than those in healthy people. (2) The changes of blood and urinary Col-Ⅳ, LN levels may reflect the changes of renal pathology to a certain extent, and the mesangial cell matrix hyperplasia, interstitial fibrosis, glomerular sclerosis have a certain relationship. However, the levels of Col-Ⅳ and LN in blood mainly reflect the active metabolism of Col-Ⅳ and LN, which is more closely related to the mesangial cell proliferation. The urinary Col-Ⅳ and LN levels are more related to the proliferation of matrix and interstitial fibrosis close. There is a correlation between them. Therefore, the monitoring of blood and urine Col-Ⅳ, LN dynamic changes, comprehensive judgment, for the monitoring of renal fibrosis tendencies have some value.