CAJ | 학술논문

目的探讨慢性肾脏病(CKD)5期患者桡动脉中骨形态发生蛋白(BMP)拮抗剂gremlin表达与血管钙化的关系.方法 40例CKD5期患者为试验组,于行首次动静脉内瘘术时取桡动脉标本；38例单纯外伤性脾破裂患者为对照组,取其脾小梁动脉标本.用钙盐特异性染色法( von Kossa)对动脉进行钙化染色；用免疫组化法检测动脉gremlin、BMP-2、-7的表达,并用ELISA法检测血清中3者浓度；用病理图像分析系统(IPP6.0)对组织切片进行半定量化图像分析；用SPSS 19.0统计分析软件进行数据处理.结果试验组12例(30％)钙盐染色显著阳性,位于中膜的平滑肌细胞层,而对照组无显著钙盐染色.试验组钙盐染色显著阳性的桡动脉均有gremlin、BMP-2显著表达,位于中膜的平滑肌细胞层,且2者的表达量与钙盐染色程度均呈正相关.试验组BMP-7的表达量显著低于对照组.结论 gremlin、BMP-2均可能参与了CKD5期患者桡动脉平滑肌细胞向成骨样细胞表型转化这一过程,而BMP-7可能阻止此过程的进展.
목적 탐토만성신장병(CKD)5기환자뇨동맥중골형태발생단백(BMP)길항제gremlin표체여혈관개화적관계.방법 40례CKD5기환자위시험조,우행수차동정맥내루술시취뇨동맥표본；38례단순외상성비파렬환자위대조조,취기비소량동맥표본.용개염특이성염색법( von Kossa)대동맥진행개화염색；용면역조화법검측동맥gremlin、BMP-2、-7적표체,병용ELISA법검측혈청중3자농도；용병리도상분석계통(IPP6.0)대조직절편진행반정양화도상분석；용SPSS 19.0통계분석연건진행수거처리.결과 시험조12례(30％)개염염색현저양성,위우중막적평활기세포층,이대조조무현저개염염색.시험조개염염색현저양성적뇨동맥균유gremlin、BMP-2현저표체,위우중막적평활기세포층,차2자적표체량여개염염색정도균정정상관.시험조BMP-7적표체량현저저우대조조.결론 gremlin、BMP-2균가능삼여료CKD5기환자뇨동맥평활기세포향성골양세포표형전화저일과정,이BMP-7가능조지차과정적진전.
Objective To study the association of the expression of bone morphogenetic protein (BMP) antagonist gremlin and vascular calcification in radial arteries of patients with stage 5 of chronic kidney disease (CKD).Methods Radial arteries of 40 patients with stage 5 of CKD were collected as specimens of the study group,which were trimmed off during arterial venous fistula operations.Splenic trabecular arteries were collected as specimens of the control group,which were removed from 38 patients with simple traumatic splenic rupture.All the arteries were examined histologically for calcification with yon Kossa stain.Expressions of gremlin and BMP-2,-7were detected by immunohistochemistry and their serum concentrations were detected by ELISA.Images of histological sections were semi-quantitatively analyzed by Image-Pro Plus 6.0.SPSS 19.0software was used to perform statistical analysis.Results Significantly positive von Kossa stain was found in radial arteries from 12 of 40 patients (30％) in study group,which located in the layer of medial smooth muscle cells.However,there was no obvious positive stain in control group.Additionally,in study group,significant expressions of gremlin and BMP-2 were detected in those radial arteries of positive yon Kossa stain,which also located in the layer of medial smooth muscle cells.Positive correlations were found among gremlin expression level,BMP-2 expression level and yon Kossa stain intensity.However,the BMP-7 expression intensity in arteries of study group was much weaker as compared to control group.Conclusions Both gremlin and BMP-2 may be involved in the process that the smooth muscle cells of radial arteries in patients with stage 5 of CKD phenotypically transform into osteoblast-like cells.However,BMP-7 possibly prevents this process.