医学研究生学报
醫學研究生學報
의학연구생학보
JOURNAL OF MEDICAL POSTGRADUATE
2014年
11期
1176-1179
,共4页
郑敬民%尹广%恽时锋%王建平%刘志红
鄭敬民%尹廣%惲時鋒%王建平%劉誌紅
정경민%윤엄%운시봉%왕건평%류지홍
类胰蛋白酶%肥大细胞%糖尿病肾病
類胰蛋白酶%肥大細胞%糖尿病腎病
류이단백매%비대세포%당뇨병신병
Tryptase%Mast cells%Diabetic nephropathy
目的:肥大细胞与糖尿病肾病( diabetic nephropathy, DN)的一些临床病理指标具有显著相关性,但确切病理意义仍有需进一步论证。文中通过检测肥大细胞特异性表达的含量最为丰富的丝氨酸蛋白酶———类胰蛋白酶在DN患者尿液中的表达情况,分析其与DN发生发展的关系,探讨类胰蛋白酶和肥大细胞与DN肾组织损伤的关系。方法收集2012年1月至2013年6月来南京军区南京总医院全军肾脏病研究所就诊的103例DN患者尿液,分为DN早期组(微量蛋白尿期,10例)、DN中期组(显性蛋白尿期,31例)和DN晚期组(肾功能不全期,62例),同时收集20例正常人尿液作为对照组;利用ELISA方法检测尿中类胰蛋白酶水平;比较分析对照组、DN早期组、DN中期组和DN晚期组尿液中类胰蛋白酶的变化情况,并分析尿液中类胰蛋白酶水平与患者各临床指标的相关性。结果①对照组中17人尿液中未检测到类胰蛋白酶(<1.0 ng/mg肌酐),而DN组尿液中类胰蛋白酶的水平显著升高,并表现为随DN的发展而逐渐增加的趋势早期组(11.6±10.5) ng/mg肌酐、中期组(29.7±19.2)ng/mg肌酐、晚期组(44.6±43.4)ng/mg肌酐。②相关性分析显示,DN患者尿液类胰蛋白酶水平与血肌酐(r=0.325, P<0.01)、血胱蛋白酶抑制剂C(r=0.391, P<0.01)、血尿素氮(r=0.27, P<0.01)、24 h尿蛋白(r=0.389, P<0.01)、尿C3(r=0.276, P<0.05)、尿视黄醇结合蛋白(r=0.365, P<0.01)、尿溶菌酶(r=0.461, P<0.01),尿N-乙酰-β-葡萄糖苷酶(r=0.568, P<0.01)、尿肾损伤分子-1(r=0.434, P<0.05)和尿IL-18水平(r=0.375, P<0.05)均具有相关性,而与年龄、性别、空腹血糖、餐后血糖、糖化血红蛋白水平、血三酰甘油浓度、高密度脂蛋白和低浓度脂蛋白浓度则无明显相关性。结论肥大细胞在DN中具有重要作用,肥大细胞很可能是DN防治的有效新靶标。
目的:肥大細胞與糖尿病腎病( diabetic nephropathy, DN)的一些臨床病理指標具有顯著相關性,但確切病理意義仍有需進一步論證。文中通過檢測肥大細胞特異性錶達的含量最為豐富的絲氨痠蛋白酶———類胰蛋白酶在DN患者尿液中的錶達情況,分析其與DN髮生髮展的關繫,探討類胰蛋白酶和肥大細胞與DN腎組織損傷的關繫。方法收集2012年1月至2013年6月來南京軍區南京總醫院全軍腎髒病研究所就診的103例DN患者尿液,分為DN早期組(微量蛋白尿期,10例)、DN中期組(顯性蛋白尿期,31例)和DN晚期組(腎功能不全期,62例),同時收集20例正常人尿液作為對照組;利用ELISA方法檢測尿中類胰蛋白酶水平;比較分析對照組、DN早期組、DN中期組和DN晚期組尿液中類胰蛋白酶的變化情況,併分析尿液中類胰蛋白酶水平與患者各臨床指標的相關性。結果①對照組中17人尿液中未檢測到類胰蛋白酶(<1.0 ng/mg肌酐),而DN組尿液中類胰蛋白酶的水平顯著升高,併錶現為隨DN的髮展而逐漸增加的趨勢早期組(11.6±10.5) ng/mg肌酐、中期組(29.7±19.2)ng/mg肌酐、晚期組(44.6±43.4)ng/mg肌酐。②相關性分析顯示,DN患者尿液類胰蛋白酶水平與血肌酐(r=0.325, P<0.01)、血胱蛋白酶抑製劑C(r=0.391, P<0.01)、血尿素氮(r=0.27, P<0.01)、24 h尿蛋白(r=0.389, P<0.01)、尿C3(r=0.276, P<0.05)、尿視黃醇結閤蛋白(r=0.365, P<0.01)、尿溶菌酶(r=0.461, P<0.01),尿N-乙酰-β-葡萄糖苷酶(r=0.568, P<0.01)、尿腎損傷分子-1(r=0.434, P<0.05)和尿IL-18水平(r=0.375, P<0.05)均具有相關性,而與年齡、性彆、空腹血糖、餐後血糖、糖化血紅蛋白水平、血三酰甘油濃度、高密度脂蛋白和低濃度脂蛋白濃度則無明顯相關性。結論肥大細胞在DN中具有重要作用,肥大細胞很可能是DN防治的有效新靶標。
목적:비대세포여당뇨병신병( diabetic nephropathy, DN)적일사림상병리지표구유현저상관성,단학절병리의의잉유수진일보론증。문중통과검측비대세포특이성표체적함량최위봉부적사안산단백매———류이단백매재DN환자뇨액중적표체정황,분석기여DN발생발전적관계,탐토류이단백매화비대세포여DN신조직손상적관계。방법수집2012년1월지2013년6월래남경군구남경총의원전군신장병연구소취진적103례DN환자뇨액,분위DN조기조(미량단백뇨기,10례)、DN중기조(현성단백뇨기,31례)화DN만기조(신공능불전기,62례),동시수집20례정상인뇨액작위대조조;이용ELISA방법검측뇨중류이단백매수평;비교분석대조조、DN조기조、DN중기조화DN만기조뇨액중류이단백매적변화정황,병분석뇨액중류이단백매수평여환자각림상지표적상관성。결과①대조조중17인뇨액중미검측도류이단백매(<1.0 ng/mg기항),이DN조뇨액중류이단백매적수평현저승고,병표현위수DN적발전이축점증가적추세조기조(11.6±10.5) ng/mg기항、중기조(29.7±19.2)ng/mg기항、만기조(44.6±43.4)ng/mg기항。②상관성분석현시,DN환자뇨액류이단백매수평여혈기항(r=0.325, P<0.01)、혈광단백매억제제C(r=0.391, P<0.01)、혈뇨소담(r=0.27, P<0.01)、24 h뇨단백(r=0.389, P<0.01)、뇨C3(r=0.276, P<0.05)、뇨시황순결합단백(r=0.365, P<0.01)、뇨용균매(r=0.461, P<0.01),뇨N-을선-β-포도당감매(r=0.568, P<0.01)、뇨신손상분자-1(r=0.434, P<0.05)화뇨IL-18수평(r=0.375, P<0.05)균구유상관성,이여년령、성별、공복혈당、찬후혈당、당화혈홍단백수평、혈삼선감유농도、고밀도지단백화저농도지단백농도칙무명현상관성。결론비대세포재DN중구유중요작용,비대세포흔가능시DN방치적유효신파표。
Objective Increased renal mast cells have been found in significant correlation with clinicopathological features of diabetic nephropathy ( DN) .However, the exact pathological significance of mast cells still remained to be elucidated.As one of the most abundant serine proteases, tryptase is specifically expressed by mast cells.The study was to observe the expression of tryptase in the urine of patients with diabetic nephropathy and realize the pathological significance of urinary tryptase and renal mast cells in the development of diabetic nephropathy. Methods Urine samples from 103 patients with diabetic nephropathy who were hospitalized at the clinical unit of the nephrology centre of Jingling Hospital from January 2012 to June 2013 were collected.According to concentra-tion of urinary albumin excretion rate, the patients were conducted to early-stage DN group (microalbuminuria,n=10), middle-stage DN group (proteinuria stage, n=31) and end-stage DN group (renal insufficiency stage,n=62).Meanwhile, urine samples from 20 normal persons were taken as the normal control group.Tryptase level in each urine sample was measured by using an ELISA kit.The average tryptase levels were compared among different groups and the correlation between urinary tryptase level and clinical indices was analyzed. Results ①In most cases, tryptase was not detected in the urine samples from normal persons(0.7 ±1.4 ng/mg creati-nine).However, the urinary trypatse level increased significantly with the development of diabetic nephropathy (11.6 ±10.5 ng/mg creatinine for early stage, 29.7 ±19.2 ng/mg creatinine for middle stage, and 44.6 ±43.4 ng/mg creatinine for late stage group).②The urinary tryptase level was found in significant correlation with ser-um creatinine (r=0.325, P<0.01), serum cystatin C (r=0.391, P<0.01), serum urea nitrogen (r=0.27, P<0.01), 24 hour uri-nary protein (r=0.389, P<0.01), urine C3 (r=0.276, P<0.05), urine retinol-binding protein (r=0.365, P<0.01), urine lysozyme (r=0.461, P<0.01), urine N-acetyl-β-glucosaminidase level (r=0.568, P<0.01), urinary kidney injury molecule-1 (r=0.434, P<0.05) and interleukin-18 level (r=0.375, P<0.05).No significant correlation was found between urinary tryptase level and age, gender, fasting blood sugar, postprandial blood sugar, HbA1c, triglyceride, high density lipoprotein or low density lipo-protein. Conclusion Mast cells play an important role in the development of diabetic nephropathy and might be a novel and effective target for the treatment of DN.