CAJ | 학술논문

目的探讨慢性肾脏病(CKD)5期患者桡动脉中核心结合因子(Cbfα-1)和Ⅱ型胶原(Col Ⅱ)表达及其与血管钙化发生的关系.方法 40例CKD5期患者在接受动-静脉内瘘手术时,留取一段桡动脉.对10例在本院接受胃大部切除术、肾功能正常患者,留取一段胃左动脉为对照组.钙盐沉积采用von Kossa染色法,根据von Kossa染色结果,CKD5期组又分为CKD5期无钙化组、轻中度钙化组和重度钙化组.Cbfα-1和ColⅡ的表达采用免疫组化染色法.同时测定血钙、磷、甲状旁腺激素(iPTH)、C反应蛋白(CRP)水平.结果 40例CKD5期患者中有17例(42.5％)出现血管钙化,主要发生在血管中膜,对照组均未见血管钙化发生.CKD5期轻中度钙化组和重度钙化组中,动脉中膜均有Cbfα-1、ColⅡ的阳性表达；23例CKD5 期无钙化组中,有18例(78.3％)至少有Cbfα-1、ColⅡ其中一种的阳性表达.对照组均无Cbfα-1、C0lⅡ的阳性表达.CKD5期轻中度钙化组和重度钙化组,血管中膜Cbfα-1、ColⅡ免疫组化的阳性率均显著高于CKD5期无钙化组,但轻中度钙化组和重度钙化组之间的差异无统计学意义.CRP、钙磷乘积与Cbfα-1、ColⅡ呈正相关；血磷与Cbfα-1(r=0.786,P＜0.01)、ColⅡ(r=0.785,P＜0.01)呈正相关.结论 CKD5期患者桡动脉钙化以中膜为主,钙化的动脉均有Cbfα-1、Col Ⅱ的高表达,且其表达早于组织学上血管钙化的发生.Cbfα-1和ColⅡ可能在血管钙化的发生、发展中起到了重要作用.
목적 탐토만성신장병(CKD)5기환자뇨동맥중핵심결합인자(Cbfα-1)화Ⅱ형효원(Col Ⅱ)표체급기여혈관개화발생적관계.방법 40례CKD5기환자재접수동-정맥내루수술시,류취일단뇨동맥.대10례재본원접수위대부절제술、신공능정상환자,류취일단위좌동맥위대조조.개염침적채용von Kossa염색법,근거von Kossa염색결과,CKD5기조우분위CKD5기무개화조、경중도개화조화중도개화조.Cbfα-1화ColⅡ적표체채용면역조화염색법.동시측정혈개、린、갑상방선격소(iPTH)、C반응단백(CRP)수평.결과 40례CKD5기환자중유17례(42.5％)출현혈관개화,주요발생재혈관중막,대조조균미견혈관개화발생.CKD5기경중도개화조화중도개화조중,동맥중막균유Cbfα-1、ColⅡ적양성표체；23례CKD5 기무개화조중,유18례(78.3％)지소유Cbfα-1、ColⅡ기중일충적양성표체.대조조균무Cbfα-1、C0lⅡ적양성표체.CKD5기경중도개화조화중도개화조,혈관중막Cbfα-1、ColⅡ면역조화적양성솔균현저고우CKD5기무개화조,단경중도개화조화중도개화조지간적차이무통계학의의.CRP、개린승적여Cbfα-1、ColⅡ정정상관；혈린여Cbfα-1(r=0.786,P＜0.01)、ColⅡ(r=0.785,P＜0.01)정정상관.결론 CKD5기환자뇨동맥개화이중막위주,개화적동맥균유Cbfα-1、Col Ⅱ적고표체,차기표체조우조직학상혈관개화적발생.Cbfα-1화ColⅡ가능재혈관개화적발생、발전중기도료중요작용.
Objective To study the relationship between the medial artery calcification and expression of core-binding factor alpha 1 (Cbf α-1) and collagen Ⅱ (Col Ⅱ) in chronic kidney disease (CKD) stage 5 patients.Methods Pieces of radial arteries were taken from 40 patients with CKD stage 5 during internal arteriovenous fistula operation.Ten patients with subtotal gastrectomy and normal renal function were chosen as control.The vessels were examined for calcification by von Kossa stain and for the presence of Cbfα-1 and Col Ⅱ by immunohistochemistry.According to von Kossa stain,CKD stage 5 patients were divided into no calcification group,mild-moderate calcification group and severe calcification group.Other related factors including serum calcium,phosphate,intact parathyroid hormone (iPTH),C-reactive protein (CRP),triglyceride(TG),cholesterol(TC) and lowdensity lipoproteins(LDL) were also detected.Results Seventeen (42.5％) of CKD Stage 5 patients showed vascular calcification,while calcification was not found in controls.Most calcification occurred in medial layer.Positive immunohistochemical staining of core-binding factor and Col Ⅱ was found in the smooth muscular cell plasma of medial layer in the vessels with calcification.However,above positive staining was also observed in 78.3％ of no calcification group.But there was little staining in control group.Positive staining score of Cbfα-1 and Col Ⅱ in severe calcification group was significantly higher than that in no calcification group.Same findings were obtained in mild-moderate calcification group,but the difference between them was not statistically significant.CRP and Ca × P were positively correlated with staining score of Cbfα-1 and Col Ⅱ.Serum phosphate was positively correlated with Cbfα-1 (r=0.786,P＜0.01) and Col Ⅱ (r=0.785,P＜0.01) respectively.Conclusions 42.5％ of CKD stage 5 patients in our group shows vascular calcification,which occurrs mainly in medial layer.High expression of Cbfα-1 and Col Ⅱ can be observed in vascular calcification of radial arteries,which is earlier than vascular histological changes.Cbfα-1 and Col Ⅱ may be involved in the development of vascular calcification.