CAJ | 학술논문

目的:分析肾脏足细胞特异蛋白podocalyxin(PCX)的表达和尿足细胞数在紫癜性肾炎(HenochSch(o)nlein purpura nephritis,HSPN)病理进展过程中的变化.方法:56例HSPN患儿为病例组,根据肾脏病理改变分为4组:HSPN Ⅱ (Ⅱa+Ⅱb)级组(n=10),Ⅲ (Ⅲa+Ⅲb)级组(n=21),Ⅳ级组(n=16)和Ⅴ级组(n=9)；另取非肾脏疾病死亡病例尸检切取的肾脏标本4例作为正常肾组织对照组；同时收集8例健康儿童的晨尿作正常尿液对照组.应用免疫荧光方法检测PCX在4例正常肾组织及56例HSPN肾组织中的表达,并对其结果进行定量分析；同时检测8例健康儿童及56例HSPN患儿尿足细胞阳性的发生率和尿足细胞数.结果:在正常对照组和HSPN Ⅱ (Ⅱa+Ⅱb)级组的肾组织中,PCX表达完整,2组之间肾组织PCX阳性面积占肾小球面积的百分比差异无统计学意义(P＞0.05)；在HSPN Ⅲ(Ⅲa+Ⅲb)级、Ⅳ级和Ⅴ级组的肾组织中,PCX表达均有不同程度缺失,从Ⅲ (Ⅲa+Ⅲb)～Ⅴ级其表达依次下降,各组间比较差异有统计学意义(P＜0.01)；病理分级在Ⅲ (Ⅲa+Ⅲb)级以上的HSPN,尿中有PCX的阳性表达,提示尿中有足细胞存在；肾组织PCX荧光阳性面积占肾小球的百分比与尿中足细胞数呈负相关(r=0.637,P＜0.01).结论:足细胞损伤在儿童HSPN病理进展中发挥一定作用；可以在一定程度上反映HSPN的病理损伤程度.
목적:분석신장족세포특이단백podocalyxin(PCX)적표체화뇨족세포수재자전성신염(HenochSch(o)nlein purpura nephritis,HSPN)병리진전과정중적변화.방법:56례HSPN환인위병례조,근거신장병리개변분위4조:HSPN Ⅱ (Ⅱa+Ⅱb)급조(n=10),Ⅲ (Ⅲa+Ⅲb)급조(n=21),Ⅳ급조(n=16)화Ⅴ급조(n=9)；령취비신장질병사망병례시검절취적신장표본4례작위정상신조직대조조；동시수집8례건강인동적신뇨작정상뇨액대조조.응용면역형광방법검측PCX재4례정상신조직급56례HSPN신조직중적표체,병대기결과진행정량분석；동시검측8례건강인동급56례HSPN환인뇨족세포양성적발생솔화뇨족세포수.결과:재정상대조조화HSPN Ⅱ (Ⅱa+Ⅱb)급조적신조직중,PCX표체완정,2조지간신조직PCX양성면적점신소구면적적백분비차이무통계학의의(P＞0.05)；재HSPN Ⅲ(Ⅲa+Ⅲb)급、Ⅳ급화Ⅴ급조적신조직중,PCX표체균유불동정도결실,종Ⅲ (Ⅲa+Ⅲb)～Ⅴ급기표체의차하강,각조간비교차이유통계학의의(P＜0.01)；병리분급재Ⅲ (Ⅲa+Ⅲb)급이상적HSPN,뇨중유PCX적양성표체,제시뇨중유족세포존재；신조직PCX형광양성면적점신소구적백분비여뇨중족세포수정부상관(r=0.637,P＜0.01).결론:족세포손상재인동HSPN병리진전중발휘일정작용；가이재일정정도상반영HSPN적병리손상정도.
Objective:To analyze the podocalyxin (PCX) expression in the kidney and the number of urinary podocytes in different pathological grades of Henoch-Sch(o)nlein purpura nephritis (HSPN),and to determine whether the number of urinary podocytes reflects the renal damage in HSPN.Methods:Fifty-six children diagnosed with HSPN in our hospital were enrolled in the study and classified into 4 groups by renal pathology:grade Ⅱ (Ⅱa+Ⅱb) (n=10),grade Ⅲ (Ⅲa+Ⅲb) (n=21),grade Ⅳ (n=16),and grade Ⅴ (n=9).Four kidney autopsy specimens without histomorphologic lesions and 8 urine samples from healthy children served as controls.With immunofluorescence assay,the PCX expression in 4 normal renal tissues and in the renal tissues of the 56 HSPN children was detected and quantitatively analyzed.Positive rate and the number of urinary podocytes were detected in the 8 healthy children and 56 HSPN children.Results:In the renal tissues of the normal control group and grade Ⅱ (Ⅱa+Ⅱb) HSPN group,the PCX expression was complete.The percentage of the PCX positive area out of the total glomerular area in the renal tissues of 2 groups had no significant difference (P＞0.05).In the renal tissues of grade Ⅲ (Ⅲa+Ⅲb),Ⅳ,and Ⅴ HSPN groups,the PCX expression showed various degrees of loss,decreasing in turn from grade Ⅱ (Ⅱa+Ⅱb),Ⅲ (Ⅲa+Ⅲb),Ⅳ to Ⅴ,with significant differences between each group (P＜0.01).For HSPN with grade Ⅲ (Ⅲa+Ⅲb) or higher,positive PCX expression was found in the urine,suggesting the presence of enough podocytes in the urine.The percentage of fluorescence positive area out of the total glomerular area of PCX in the renal tissues was negatively correlated with the total number of urinary podocytes (r=-0.637,P＜0.01).Conclusion:Podocyte injury plays a certain role in the pathological progression of HSPN.The urinary detection ofpodocytes can reflect the degrees of pathological damage in HSPN.