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目的 :探讨细胞型局灶节段性肾小球硬化症 (focalsegmentalglomerulosclerosis ,FSGS)的病理学特征及其细胞周期调控蛋白的表达。方法 :收集细胞型FSGS病例 1 7例 ,肾活检标本进行系统的光镜、免疫荧光及电镜观察 ,通过免疫组化及免疫电镜方法 ,检测细胞周期蛋白 (cyclinD1 ,cyclinE ,cyclinA及cyclinB1 ) ,细胞周期蛋白依赖激酶抑制剂 (cyclindependentkinaseinhibitor CKI ,包括p2 1 ,p2 7及 p5 7)的表达。 结果 :细胞型FSGS以上皮细胞增生肥大伴有毛细血管襻的节段硬化或塌陷为突出特征 ;免疫荧光可见部分病例节段性IgM阳性或阴性 ;超微结构观察显示增生的细胞兼具足细胞及壁层上皮细胞的特征。细胞型FSGS的增生细胞 ,cyclinE、cyclinA、cyclinB1及p2 1表达阳性 ,而cyclinD1、p2 7及p5 7转为阴性。 结论 :细胞型FSGS的增生细胞可能为损伤的足细胞重现幼稚足细胞的表型特征 ,重新进入细胞周期进行增殖而形成细胞增生病变 ;细胞周期蛋白 (cyclinE ,cyclinA ,cyclinB1 )表达增加及CKI(p2 7,p5 7)表达降低与细胞增生病变的细胞周期调控有关。
Objective: To investigate the pathological features and expression of cell cycle regulatory proteins in focal segmental glomerulosclerosis (FSGS). Methods: Seventeen cases of cell type FSGS were collected and examined by light microscopy, immunofluorescence and electron microscopy. The expressions of cyclinD1, cyclinE, cyclinA and cyclinB1 were detected by immunohistochemistry and immunoelectron microscopy. Expression of cyclin dependent kinase inhibitor CKI, including p21, p27 and p5 7. RESULTS: The cell type FSGS was characterized by segmental sclerosis or collapse of epithelial hypertrophy accompanied by capillary loop. The immunofluorescence showed that some cases were positive or negative of segmental IgM. The ultrastructural observation showed that both proliferative cells and podocytes And the characteristics of parietal epithelial cells. The expression of cyclinE, cyclinA, cyclinB1 and p21 in proliferating cells of FSGS was positive, while the expressions of cyclinD1, p27 and p57 were negative. CONCLUSIONS: The proliferating cells of FSGS-derived proliferative cells may reprogram the phenotypic characteristics of naive podocytes and re-enter the cell cycle to proliferate to form cell proliferative lesions. The expression of cyclin E, cyclinB1 and CKI (p27, p5 7) decreased expression of cell proliferation and cell cycle regulation.