CAJ | 학술논문

目的：检测成人不同病理类型肾病综合征患者肾小管 Megalin 表达的差异，进一步探讨肾病综合征患者蛋白尿形成和肾小管损伤的发生机制。方法选取我院确诊为原发性肾病综合征患者62例，按照肾脏病理分为微小病变组（MCD）、膜性肾病组（MN）、局灶节段硬化组（FSGS）。收集各病例组临床资料以及血清、尿液等临床指标，包括患者病程、起效时间、ALB、BUN、Scr、CH、TG、HB、24小时尿蛋白定量等；应用免疫组织化学方法检测各病例组肾小管 megalm 的表达；各病例组行肾脏病理常规染色，并根据肾小管损伤标准进行肾小管-间质损伤程度评分。分析肾小管 megalin 表达量与临床和病理指标的相关关系。结果MCD 组肾小管 megalin 表达量与对照组比较无统计学差异，而 MN 组、FSGS 组肾小管 megalin 表达均显著低于 MCD 组和对照组，以 FSGS 组降低最为显著。各病理类型亚组肾小管 megalin 的表达水平与临床指标无显著相关关系。全组肾病综合征、MCD 亚组、MN 亚组 megalin 的表达水平均与肾小管损伤评分存在负相关关系。结论某些病理类型肾病综合征患者肾小管 megalin 表达降低可能与蛋白尿毒性有关，megalin 表达的下降反过来可能参与这些患者的尿蛋白形成。
목적：검측성인불동병리류형신병종합정환자신소관 Megalin 표체적차이，진일보탐토신병종합정환자단백뇨형성화신소관손상적발생궤제。방법선취아원학진위원발성신병종합정환자62례，안조신장병리분위미소병변조（MCD）、막성신병조（MN）、국조절단경화조（FSGS）。수집각병례조림상자료이급혈청、뇨액등림상지표，포괄환자병정、기효시간、ALB、BUN、Scr、CH、TG、HB、24소시뇨단백정량등；응용면역조직화학방법검측각병례조신소관 megalm 적표체；각병례조행신장병리상규염색，병근거신소관손상표준진행신소관-간질손상정도평분。분석신소관 megalin 표체량여림상화병리지표적상관관계。결과MCD 조신소관 megalin 표체량여대조조비교무통계학차이，이 MN 조、FSGS 조신소관 megalin 표체균현저저우 MCD 조화대조조，이 FSGS 조강저최위현저。각병리류형아조신소관 megalin 적표체수평여림상지표무현저상관관계。전조신병종합정、MCD 아조、MN 아조 megalin 적표체수평균여신소관손상평분존재부상관관계。결론모사병리류형신병종합정환자신소관 megalin 표체강저가능여단백뇨독성유관，megalin 표체적하강반과래가능삼여저사환자적뇨단백형성。
Objective Expression of megalin on renal tubule in different pathological types of nephrotic syndrome patients were detected,to explore the possible mechanisms of proteinuria and renal tubule injury.Methods 62 primary nephrotic syndrome patients were selected and divided into minimal change disease,membranous nephropathy group and focal segmental sclerosis.Clinical indicators were collected,including duration of patients,onset time,serum albumin, blood urea nitrogen,serum creatinine,cholesterol,triglycerides,hemoglobin,and 24-hour urinary protein.Immunohisto-chemistry was used to detect the megalin expression on renal tubule of each group.Renal pathology was stained by HE, PASM,and Masson staining,then the renal tubule injury scores were tested according to the the tubular injury stand-ards.Results The results of semi-quantitative analysis showed that the expression of megalin on proximal tubule be-tween the MCD group and control group has no significant difference,the expression of megalin in the MN group and FSGS group was significantly lower than in the MCD group,the expression of megalin in the FSGS group was signifi-cantly lower than in the MN group.There were no correlation between megalin expression in proximal tubule and clini-cal indicators in various pathological subgroups.Negative correlations between megalin expressions and renal tubule in-jury scores in the whole group,MCD group,MN group were found.Conclusion The decreasing expressions of megalin on proximal tubule in patients with heavier pathological types of nephrotic syndrome were in relation with the toxicity of urine protein,and this decreasing of megalin expression then contribute to formation of proteinuria.