CAJ | 학술논문

目的观察nephrin在HBV相关性膜性肾病(HBV-MN)中的表达特点,研究HBV-MN中足细胞的损伤程度及意义.方法采用免疫组化方法检测35例HBV-MN患者肾组织nephrin的表达情况,并进行半定量评分,分析其与临床病理指标的相关性.结果 35例HBV-MN患者中Ⅰ期6例、Ⅱ期20例和Ⅲ期9例.正常肾组织nephrin于肾小球上皮侧呈线性高强度表达,HBV-MN患者肾组织nephrin表达显著减少,在HBV-MN的不同分期中nephrin表达无显著性差异(P＞0.05),但肾病综合征组nephrin的表达明显低于非肾病综合征组患者(P＜0.01),且不同程度尿蛋白患者其表达也有显著性差异(P＜0.05).Spearman相关分析显示肾组织nephrin与24 h尿蛋白定量之间存在负相关(r=-0.378,P＜0.05).Ⅱ期患者呈肾病综合征者nephrin的表达也明显低于非肾病综合征患者(P＜0.01).结论 HBV-MN早期足细胞即受损伤,肾组织nephrin表达明显下调,尤其在肾病综合征患者更明显,HBV-MN中nephrin表达下调与蛋白尿的产生密切相关.
목적 관찰nephrin재HBV상관성막성신병(HBV-MN)중적표체특점,연구HBV-MN중족세포적손상정도급의의.방법 채용면역조화방법검측35례HBV-MN환자신조직nephrin적표체정황,병진행반정량평분,분석기여림상병리지표적상관성.결과 35례HBV-MN환자중Ⅰ기6례、Ⅱ기20례화Ⅲ기9례.정상신조직nephrin우신소구상피측정선성고강도표체,HBV-MN환자신조직nephrin표체현저감소,재HBV-MN적불동분기중nephrin표체무현저성차이(P＞0.05),단신병종합정조nephrin적표체명현저우비신병종합정조환자(P＜0.01),차불동정도뇨단백환자기표체야유현저성차이(P＜0.05).Spearman상관분석현시신조직nephrin여24 h뇨단백정량지간존재부상관(r=-0.378,P＜0.05).Ⅱ기환자정신병종합정자nephrin적표체야명현저우비신병종합정환자(P＜0.01).결론 HBV-MN조기족세포즉수손상,신조직nephrin표체명현하조,우기재신병종합정환자경명현,HBV-MN중nephrin표체하조여단백뇨적산생밀절상관.
ObjectiveTo observe the expression of nephrin in hepatitis B virus-associated membranous nephropathy (HBV-MN),and investigate the impairment and significance of podocyte in HBV-MN.MethodsThe protein expression of nephrin in renal biopsy specimens in 35 patients,who were diagnosed as HBV-MN by renal biopsy,was determined by immunohistochemistry and tested by semiquantitative method.The relationship between the expression of nephrin and clinicopathological data was analyzed.Results Among the 35 cases with HBV-MN,6 were in MN phase Ⅰ,20 in MN phase Ⅱ and 9 in MN phase Ⅲ.A strong intensity expression of nephrin in normal glomerulus was found along capillary loop of glomerulus,while its expression in HBV-MN patients decreased obviously.There was no significantly difference in the expression of nephrin among the different stages of HBV-MN ( P ＞ 0.05 ).The expression of nephrin in different clinical types was significantly different ( P ＜ 0.05 ).The expression of nephrin in patients with nephrotic syndrome was significantly lower than that in patients without nephrotic syndrome (P ＜0.01 ).The expression of nephrin in different grades of 24-hour urinary protein excretion quantity was significantly different( P ＜ 0.05 ).There was negative correlation between the expression of nephrin and 24-hour urinary protein excretion quantity(r = -0.378,P ＜ 0.05).In the patients with HBV-MN phase Ⅱ,the expression of nephrin in patients with nephrotic syndrome was also significantly lower than that in patients without nephrotic syndrome( P ＜ 0.01 ).Conclusions The damage of podocytes emerge in the early stage of HBV-MN and the expression of nephrin in HBV-MN patients,especially in patients with nephrotic syndrome,are significantly down regulated.The descended expression of nephrin in HBV-MN patients may promote the production of proteinuria.