Division of Nephrology, Department of Medicine, Tri-Service General Hospital, Taiwan.
Clin Chim Acta. 2010 May 2;411(9-10):700-4. doi: 10.1016/j.cca.2010.01.036. Epub 2010 Feb 4.
Diabetic nephropathy (DN) occurs in 20% to 30% of all patients with type 2 diabetes mellitus (DM) and is the most common cause of end-stage renal disease. However, the definite pathogenesis, especially the role of immune response, is still unclear.
We studied the production and expression of Th1 (IFN-gamma, IL-2R), Th2 (IL-4, IL-10), proinflammatory cytokines (IL-1beta, and TNF-alpha), and chemokines (MCP-1, and RANTES) in patients with DN. The correlation among cytokines, chemokines, and clinical parameters were examined.
A patient with DN presented with longer disease duration, heavy proteinuria, and impaired renal function. Our results demonstrated increased proinflammatory cytokines, Th1 cytokines and chemokines, but not Th2 cytokines, in the plasma and urine of patients with DN as compared to patients with DM without overt nephropathy. Enhanced cytokine/chemokine activation in DN was also demonstrated by positive immunohistochemical staining of kidney tissue. We found a positive correlation between daily protein loss and plasma IFN-gamma and IL-2R, and urinary MCP-1, as well as a negative correlation between creatinine clearance and plasma TNF-alpha and urinary MCP-1.
There were aberrant cytokines/chemokines production correlated with the degree of proteinuria in patient with overt DN and gross proteinuria. Inflammation may be important in the pathogenesis of DN.
在所有 2 型糖尿病患者中，有 20%至 30%发生糖尿病肾病（DN），是终末期肾病的最常见病因。然而，确切的发病机制，尤其是免疫反应的作用，仍不清楚。
我们研究了 DN 患者 Th1（IFN-γ、IL-2R）、Th2（IL-4、IL-10）、前炎症细胞因子（IL-1β和 TNF-α）和趋化因子（MCP-1 和 RANTES）的产生和表达。检查了细胞因子、趋化因子与临床参数之间的相关性。
患有 DN 的患者表现为疾病持续时间较长、大量蛋白尿和肾功能受损。与无显性肾病的 DM 患者相比，我们的结果表明，DN 患者的血浆和尿液中前炎症细胞因子、Th1 细胞因子和趋化因子增加，但 Th2 细胞因子没有增加。肾脏组织的免疫组织化学染色也显示了 DN 中细胞因子/趋化因子的增强激活。我们发现每日蛋白丢失与血浆 IFN-γ和 IL-2R 以及尿 MCP-1呈正相关，而肌酐清除率与血浆 TNF-α和尿 MCP-1呈负相关。
在有显性蛋白尿和大量蛋白尿的 DN 患者中，存在与蛋白尿程度相关的异常细胞因子/趋化因子产生。炎症可能在 DN 的发病机制中起重要作用。
