Nakahara C, Nagata M, Watanabe T, Kobayashi K, Hamaguchi H, Kanemoto K, Kashiwagi R, Matsui A
Department of Pediatrics, University of Tsukuba, Japan.
Clin Nephrol. 1999 Sep;52(3):131-8.
To address the clinical significance of lipoprotein (a) (Lp(a)) deposition in renal diseases of children, we examined renal localization of apolipoprotein (a) (apo(a)), which is the major apoprotein of Lp(a), using a new monoclonal antibody as a probe, and compared histological changes and clinical courses between the cases with and without apo(a) accumulation. Our study comprised 78 cases with various renal diseases.
Of the 78 cases, 45 showed apo(a) deposition (group A) and the other 33 did not (group B). Nephrotic syndrome was similarly presented in groups A and B (46.7% vs 36.3%). Histological findings were analyzed in 62 proliferative and 16 non-proliferative original diseases separately. In the cases with proliferative diseases, severe histological changes were observed in group A more than in group B, severe proliferation (50.9% vs 26.1%: p < 0.01) and crescent formation (11.9% vs 5.1%: p < 0.01) were observed in group A over that of group B. However, the clinical status at the latest follow-up were quite similar, there was no difference of favorable (60.5% vs 62.5%) and unfavorable outcome (15.9% vs 16.7%) in groups A and B. In the cases with non-proliferative diseases, global sclerosis was more often encountered in group A than in group B (28.3% vs 6.5%). Group A carried poorer prognosis than group B in non-proliferative diseases.
These results suggest that apo(a) deposits just passively follow the histological injury, and they do not always accelerate it.
为探讨脂蛋白（a）[Lp（a）]在儿童肾脏疾病中的沉积的临床意义，我们使用一种新的单克隆抗体作为探针，检测载脂蛋白（a）[apo（a）]（Lp（a）的主要载脂蛋白）在肾脏中的定位，并比较有和没有apo（a）蓄积的病例之间的组织学变化和临床病程。我们的研究包括78例患有各种肾脏疾病的病例。
78例病例中，45例显示apo（a）沉积（A组），另外33例未显示（B组）。A组和B组肾病综合征的发生率相似（46.7%对36.3%）。分别对62例增生性和16例非增生性原发疾病的组织学结果进行了分析。在增生性疾病病例中，A组观察到的严重组织学变化比B组更多，A组观察到的严重增生（50.9%对26.1%：p<0.01）和新月体形成（11.9%对5.1%：p<0.01）比B组更多。然而，最近一次随访时的临床状况非常相似，A组和B组的良好结局（60.5%对62.5%）和不良结局（15.9%对16.7%）没有差异。在非增生性疾病病例中，A组比B组更常出现全球硬化（28.3%对6.5%）。在非增生性疾病中，A组的预后比B组差。
这些结果表明，apo（a）沉积物只是被动地伴随组织学损伤，并不总是加速损伤。
