Hernández-Arteaga Kriscia, Soto-Abraham Virgilia, Pérez-Navarro Monserrat, de León-Garza Bernardo, Rodríguez-Matías Adrian, Olvera-Soto M Guadalupe, Valdez-Ortiz Rafael
Clin Nephrol. 2018 Jun;89(6):429-437. doi: 10.5414/CN109240.
Thrombotic microangiopathy (TMA) has been associated with diabetic nephropathy, but its pathogenesis is unknown.
To determine the role of vascular endothelial growth factor (VEGF) expression in patients with TMA and diabetes mellitus.
Retrospective cohort study, patients were divided into diabetic nephropathy patients either without thrombotic microangiopathy (DN-TMA) or with thrombotic microangiopathy (DN+TMA). VEGF levels were analyzed using immunohistochemistry. Statistical analysis was performed with SPSS 20.0 software.
There were 36 patients included in this study with a mean age of 47.6 ± 9.3 years. The average time since the diagnosis of diabetes mellitus was 6.8 ± 4.1 years. There were 21 patients (58.3%) with DN+TMA and 15 patients (41.7%) with DN-TMA. Patients with DN+TMA had a higher systolic blood pressure (p = 0.014) and diastolic blood pressure (p < 0.001) as well as proteinuria (p = 0.006), and a lower rate of glomerular filtration at baseline (p = 0.01). VEGF assessment showed lower arteriolar and glomerular expression in patients with DN+TMA (p < 0.001). The VEGF expression levels had an inverse relationship with proteinuria (r = -0.373; p = 0.03) and were directly proportional with glomerular filtration (r = 0.712; p < 0.01). Kaplan-Meier curves showed a higher probability of end-stage renal disease in patients with DN+TMA (log-rank p < 0.012).
CONCLUSION: TMA is associated with low VEGF expression and end-stage renal disease in patients with diabetic nephropathy. .
血栓性微血管病（TMA）与糖尿病肾病相关，但其发病机制尚不清楚。
确定血管内皮生长因子（VEGF）表达在TMA合并糖尿病患者中的作用。
回顾性队列研究，将患者分为无血栓性微血管病的糖尿病肾病患者（DN-TMA）和有血栓性微血管病的糖尿病肾病患者（DN+TMA）。采用免疫组织化学分析VEGF水平。使用SPSS 20.0软件进行统计分析。
本研究纳入36例患者，平均年龄47.6±9.3岁。糖尿病诊断后的平均时间为6.8±4.1年。有21例（58.3%）患者为DN+TMA，15例（41.7%）患者为DN-TMA。DN+TMA患者的收缩压（p = 0.014）、舒张压（p < 0.001）以及蛋白尿（p = 0.006）更高，且基线时肾小球滤过率更低（p = 0.01）。VEGF评估显示DN+TMA患者的小动脉和肾小球表达较低（p < 0.001）。VEGF表达水平与蛋白尿呈负相关（r = -0.373；p = 0.03），与肾小球滤过呈正相关（r = 0.712；p < 0.01）。Kaplan-Meier曲线显示DN+TMA患者发生终末期肾病的概率更高（对数秩检验p < 0.012）。
TMA与糖尿病肾病患者VEGF低表达及终末期肾病相关。
