尿足细胞排泄和足细胞蛋白表达评估 IgA 肾病的肾临床病理变化。

Evaluation of renal clinicopathological changes in IgA nephropathy by urinary podocytes excretion and podocalyxin expression.

机构信息

Department of Nephrology, The Second Xiangya Hospital, Renal Research Institute of Central South University, Central South University, Changsha, PR China.

出版信息

Ren Fail. 2012;34(7):821-6. doi: 10.3109/0886022X.2011.643352. Epub 2012 Jun 8.

DOI:10.3109/0886022X.2011.643352

PMID:22679920

Abstract

OBJECTIVE

To explore the association of urinary podocyte excretion and renal expression of podocyte-specific marker podocalyxin (PCX) with clinicopathological changes in immunoglobulin A nephropathy (IgAN).

METHODS

Morning urine samples from IgAN patients and healthy controls were collected. The expression of glomerular PCX was quantified in 50 IgAN patients diagnosed by renal biopsy. IgAN was classified based on the Lee's Grading system and scored according to the Katafuchi semiquantitative criteria. Morphological evaluation of podocyte was determined by electron microscopy.

RESULTS

The amount of urinary podocytes in the IgAN patients was significantly higher than that in the healthy controls (p < 0.01). Pairwise comparison among Lee's grades of IgAN showed that the median of urinary podocytes in Lee's I-II group was lower than that in Lee's III, IV, and V groups (p < 0.05); group III lower than group V (p < 0.05). The positive rate of urinary podocytes was the highest in Lee's IV and V groups (100%), and lowest in Lee's I-II group (55%). Multiple comparison among groups of Lee's grades of IgAN showed that the glomerular PCX expression in Lee's I-II group was higher than that in Lee's III, IV, and V groups (p < 0.05); groups III and IV higher than group V (p < 0.05). The amount of urinary podocytes in IgAN patients was negatively correlated with PCX expression (r = -0.702, p < 0.01), but positively correlated with 24-h urinary protein (r = 0.465, p < 0.01) and glomerular (r = 0.233, p < 0.01) and renal tubular pathological scores (r = 0.307, p < 0.05). The glomerular PCX expression was negatively correlated with 24-h urinary protein (r = -0.367, p < 0.05) and glomerular (r = -0.560, p < 0.05) and tubular pathological scores (r = -0.377, p < 0.05). Electron microscopy showed significant changes in podocytes of IgAN, especially in the foot process.

CONCLUSION

The amount of urinary podocyte can reflect the loss of podocytes in renal tissue, which may be a marker of IgAN progression.

摘要

目的

探讨尿足细胞排泄和肾组织中足细胞特异性标志物足细胞蛋白（PCX）与 IgA 肾病（IgAN）临床病理变化的关系。

方法

收集 50 例经肾活检诊断为 IgAN 患者和健康对照者的晨尿标本。定量分析肾小球 PCX 在 IgAN 患者中的表达。根据 Lee 分级系统对 IgAN 进行分类，并根据 Katafuchi 半定量标准进行评分。通过电子显微镜观察足细胞的形态学变化。

结果

IgAN 患者尿足细胞数明显高于健康对照组（p < 0.01）。Lee 分级的两两比较显示，Lee's I-II 组尿足细胞中位数低于 Lee's III、IV 和 V 组（p < 0.05）；III 组低于 V 组（p < 0.05）。尿足细胞阳性率在 Lee's IV 和 V 组最高（100%），在 Lee's I-II 组最低（55%）。Lee's 分级的多组比较显示，Lee's I-II 组肾小球 PCX 表达高于 Lee's III、IV 和 V 组（p < 0.05）；III 组和 IV 组高于 V 组（p < 0.05）。IgAN 患者尿足细胞数与 PCX 表达呈负相关（r = -0.702，p < 0.01），与 24 小时尿蛋白（r = 0.465，p < 0.01）、肾小球（r = 0.233，p < 0.01）和肾小管病理评分（r = 0.307，p < 0.05）呈正相关。肾小球 PCX 表达与 24 小时尿蛋白（r = -0.367，p < 0.05）、肾小球（r = -0.560，p < 0.05）和肾小管病理评分（r = -0.377，p < 0.05）呈负相关。电镜显示 IgAN 患者足细胞明显改变，尤以足突改变明显。