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目的研究肾脏淀粉样变性病患者α1-抗胰蛋白酶和蛋白溶解酶-9的表达特点,探讨其在本病进展中的作用。方法 2006年1月至2014年1月于黄石市中心医院肾内科治疗或诊断的AL型肾脏淀粉样变性病患者共60例(其中蛋白尿期42、肾病综合征期16例、尿毒症期2例),比较蛋白尿期与肾病综合征期患者血清肾功能,同时对两组肾脏切片做免疫组化观察,最后ELISA与Western blot法测定两组肾脏提取液中α1-抗胰蛋白酶与蛋白溶解酶-9表达,RT-PCR法测定mRNA表达。结果肾病综合征期患者血清血尿素氮、血肌酐、血尿素以及血尿酸明显高于蛋白尿期患者(P<0.05);肾脏切片免疫组化示,α1-抗胰蛋白酶与蛋白溶解酶-9 2个指标肾病综合征期患者明显少于蛋白尿期患者(P<0.05);ELISA以及Western blot显示α1-抗胰蛋白酶与蛋白溶解酶-9表达肾病综合征期患者均明显低于蛋白尿期患者(P<0.05),RT-PCR结果显示,α1-抗胰蛋白酶与蛋白溶解酶-9 mRNA表达肾病综合征期患者明显低于蛋白尿期患者(P<0.05)。结论α1-抗胰蛋白酶和蛋白溶解酶-9与AL型肾脏淀粉样变性病的发生与发展密切相关,今后或可作为一个治疗靶点。
Objective To investigate the expression of α1-antitrypsin and proteolytic enzyme-9 in patients with renal amyloidosis and to explore its role in the progression of this disease. Methods From January 2006 to January 2014, 60 patients with type AL renal amyloidosis treated or diagnosed by Department of Nephrology, Huangshi Central Hospital (including 42 cases of proteinuria, 16 cases of nephrotic syndrome, 2 cases of uremia Cases), compared proteinuria and nephrotic syndrome in patients with serum renal function, while the two groups of kidney sections were immunohistochemically observed by ELISA and Western blot were measured in the two groups of kidney extract α1-antitrypsin and proteolysis Enzyme-9 expression, mRNA expression was measured by RT-PCR. Results Serum urea nitrogen, serum creatinine, blood urea nitrogen and serum uric acid in patients with nephrotic syndrome were significantly higher than those in patients with proteinuria (P <0.05). Immunohistochemistry showed that α1-antitrypsin and protease-9 Two indicators of patients with nephrotic syndrome was significantly less than the proteinuria patients (P <0.05); ELISA and Western blot showed α1-antitrypsin and proteinase-9 expression nephrotic syndrome patients were significantly lower than the proteinuria (P <0.05). The results of RT-PCR showed that the expression of α1-antitrypsin and proteolytic enzyme-9 mRNA in patients with nephrotic syndrome was significantly lower than that in patients with proteinuria (P <0.05). Conclusion α1-antitrypsin and proteolytic enzyme-9 are closely related to the occurrence and development of AL type renal amyloidosis, and may be used as a therapeutic target in the future.