中华糖尿病杂志
中華糖尿病雜誌
중화당뇨병잡지
CHINES JOURNAL OF DLABETES MELLITUS
2010年
3期
196-199
,共4页
龙香菊%林珊%张鑫%商文雅
龍香菊%林珊%張鑫%商文雅
룡향국%림산%장흠%상문아
糖尿病肾病%足细胞%尿蛋白%血糖
糖尿病腎病%足細胞%尿蛋白%血糖
당뇨병신병%족세포%뇨단백%혈당
Diabetic nephropathies%Podocytes%Proteinuria%Blood glucose
目的 通过观察糖尿病肾病(DN)患者尿中足细胞及肾活检标本足细胞脱落情况,探讨尿中足细胞脱落与尿蛋白、空腹血糖、肌酐的关系.方法 选取2005年1月至2006年12月间天津医科大学总医院收治的DN患者50例,微小病变(MCD)患者25例及正常人对照组10例,按照慢性肾脏病(CKD)分期将DN患者分为5组,其中CKD I期15例,CKD Ⅱ期10例,CKD Ⅲ期8例,CKD IV期9例,CKD V期8例;另按尿蛋白量将DN患者分为3组,其中少量蛋白尿组(<1.0 g/d)13例,中量蛋白尿组(1-3.5 g/d)20例,大量蛋白尿组(>3.5 g/d)17例,采用间接免疫荧光法检测尿足细胞数目及肾小球足细胞特异性蛋白(podocalyxin,PCX)表达;分别统计各组中尿足细胞数目;同时检测各组患者24h尿蛋白、肌酐、空腹血糖,多组计量指标比较采用单因素方差分析,双变量分析采用Pearson相关分析.结果 DN组尿中足细胞的阳性率为88%(44/50);微小病变(MCD)组及正常对照组中阳性率为0;DN组患者的肾活检标本中,肾小球足细胞PCX表达缺失,MCD组肾活检标本足细胞PCX呈完整连续性表达.少量蛋白尿组尿足细胞数目(1.5±1.0)个/ml,中等量蛋白尿组(2.2±0.7)个/ml及大量蛋白尿组(3.5±1.3)个/ml,除少量蛋白尿与中量蛋白尿组差别不具有统计学意义外,其他组间差别均具有统计学意义(P<0.05).DN患者尿足细胞数目与蛋白尿(r=0.785,P<0.05)、I-Ⅲ期患者同期SCr呈正相关(r=0.466,P<0.05);而与FBG无相关性(P>0.05).结论 DN进展过程中存在足细胞损伤.DN足细胞脱落与尿蛋白、CKD I至Ⅲ期同期SCr呈正相关,与Ⅳ至V期SCr、FBG无关.
目的 通過觀察糖尿病腎病(DN)患者尿中足細胞及腎活檢標本足細胞脫落情況,探討尿中足細胞脫落與尿蛋白、空腹血糖、肌酐的關繫.方法 選取2005年1月至2006年12月間天津醫科大學總醫院收治的DN患者50例,微小病變(MCD)患者25例及正常人對照組10例,按照慢性腎髒病(CKD)分期將DN患者分為5組,其中CKD I期15例,CKD Ⅱ期10例,CKD Ⅲ期8例,CKD IV期9例,CKD V期8例;另按尿蛋白量將DN患者分為3組,其中少量蛋白尿組(<1.0 g/d)13例,中量蛋白尿組(1-3.5 g/d)20例,大量蛋白尿組(>3.5 g/d)17例,採用間接免疫熒光法檢測尿足細胞數目及腎小毬足細胞特異性蛋白(podocalyxin,PCX)錶達;分彆統計各組中尿足細胞數目;同時檢測各組患者24h尿蛋白、肌酐、空腹血糖,多組計量指標比較採用單因素方差分析,雙變量分析採用Pearson相關分析.結果 DN組尿中足細胞的暘性率為88%(44/50);微小病變(MCD)組及正常對照組中暘性率為0;DN組患者的腎活檢標本中,腎小毬足細胞PCX錶達缺失,MCD組腎活檢標本足細胞PCX呈完整連續性錶達.少量蛋白尿組尿足細胞數目(1.5±1.0)箇/ml,中等量蛋白尿組(2.2±0.7)箇/ml及大量蛋白尿組(3.5±1.3)箇/ml,除少量蛋白尿與中量蛋白尿組差彆不具有統計學意義外,其他組間差彆均具有統計學意義(P<0.05).DN患者尿足細胞數目與蛋白尿(r=0.785,P<0.05)、I-Ⅲ期患者同期SCr呈正相關(r=0.466,P<0.05);而與FBG無相關性(P>0.05).結論 DN進展過程中存在足細胞損傷.DN足細胞脫落與尿蛋白、CKD I至Ⅲ期同期SCr呈正相關,與Ⅳ至V期SCr、FBG無關.
목적 통과관찰당뇨병신병(DN)환자뇨중족세포급신활검표본족세포탈락정황,탐토뇨중족세포탈락여뇨단백、공복혈당、기항적관계.방법 선취2005년1월지2006년12월간천진의과대학총의원수치적DN환자50례,미소병변(MCD)환자25례급정상인대조조10례,안조만성신장병(CKD)분기장DN환자분위5조,기중CKD I기15례,CKD Ⅱ기10례,CKD Ⅲ기8례,CKD IV기9례,CKD V기8례;령안뇨단백량장DN환자분위3조,기중소량단백뇨조(<1.0 g/d)13례,중량단백뇨조(1-3.5 g/d)20례,대량단백뇨조(>3.5 g/d)17례,채용간접면역형광법검측뇨족세포수목급신소구족세포특이성단백(podocalyxin,PCX)표체;분별통계각조중뇨족세포수목;동시검측각조환자24h뇨단백、기항、공복혈당,다조계량지표비교채용단인소방차분석,쌍변량분석채용Pearson상관분석.결과 DN조뇨중족세포적양성솔위88%(44/50);미소병변(MCD)조급정상대조조중양성솔위0;DN조환자적신활검표본중,신소구족세포PCX표체결실,MCD조신활검표본족세포PCX정완정련속성표체.소량단백뇨조뇨족세포수목(1.5±1.0)개/ml,중등량단백뇨조(2.2±0.7)개/ml급대량단백뇨조(3.5±1.3)개/ml,제소량단백뇨여중량단백뇨조차별불구유통계학의의외,기타조간차별균구유통계학의의(P<0.05).DN환자뇨족세포수목여단백뇨(r=0.785,P<0.05)、I-Ⅲ기환자동기SCr정정상관(r=0.466,P<0.05);이여FBG무상관성(P>0.05).결론 DN진전과정중존재족세포손상.DN족세포탈락여뇨단백、CKD I지Ⅲ기동기SCr정정상관,여Ⅳ지V기SCr、FBG무관.
Objective To indicate the mechanism of podocyte injury in diabetic nephropathy(DN)patients by identifying the urinary podocytes and observe the situation of detached podocytes in glomeruli;to discuss the correlation between the urinary podocyte excretion and the proteinuria,blood glucose(FBG),serum creatinine(SCr)in DN patients by detection of theses items in different phases.Methods The DN patients were divided into five groups according to the CKD phases, and were divided into three groups according to the volume of proteinuria,namely small,medium and large-volume-proteinuria group.Urinary podocytes and the podocalyxin(PCX)expression state of podocytes in glomeruli were identified and observed by indirect immunofluorescent method. The urinary podocytes of every group were caculated respectively.Then the podocyte number were calculated respectively.Meanwhile,the 24 h proteinuria,FBG and the SCr of DN pateints were tested.The correlation among the proteinuria,SCr,FBG and the urinary podocyte number of DN pateints was analyzed statistcally.Results Urinary podocytes were found in 88 percent of patients with DN,whereas O of patients with MCD and healthy cases.The absence of expression of PCX was found in DN patients.In contrast,PCX wag expressed integrally in MCD patients.The podocytes in smallvolume-proteinuria group was(1.5±1.0)/ml,medium-volume-proteinuria group(2.2±0.7)/ml and large-volume-proteinuria group(3.5±1.3)/ml,respectively.The difference from small and medium groups were not signifficent statistically,the others were all significant.The podocyte number increased according to the proteinuria.The correlation between urinary podocyte number and proteinuria,SCr of CKD I to Ⅲ DN patients and urinary podocytes number were positive statistically.However,the correlation between SCr of CKD IV to V patients and urinary podocyte number, FBG and urinary podocyte number were not significant statistically.Condusiom the mechanism of the podocyte injury in DN patients is present.The podocyte injury in DN may positively correlate to the proteinuria and SCr of CKD I to Ⅲ patients,but the FBG and SCr of CKDIV-V patients may not correlate to the urinary podocyte number.
