Izol Volkan, Kuyucu Yurdun, Acikalin Arbil, Deger Mutlu, Aridogan Ibrahim Atilla, Polat Sait, Satar Nihat
Department of Urology,Faculty of Medicine, University of Çukurova, Adana, Turkey.
Department of Histology and Embryology, Faculty of Medicine, University of Çukurova, Adana, Turkey.
Urol J. 2019 Jun 17;16(3):279-284. doi: 10.22037/uj.v0i0.4281.
The cytokine profile and the ultrastructural changes of refluxing ureterovesical junctions(UVJs) of children treated with failed dextranomer/hyaluronic-acid (Dx/HA) injections were investigated using immunohis-tochemical methods and transmission electron microscopy(TEM).
Eighteen children who had undergone injection for reflux were included the study. The smooth muscle arrangement of the ureteral wall, transforming growth factor-? (TGF-?1),vascular-endotheli-al-growth factor (VEGF) and CD34 were evaluated immunohistochemically, and the results were compared with 10 age-matched autopsy specimens as controls. The ultrastructural evaluation and morphological description was made semi-quantitatively and compared with published data.
Four of the patients (22%) were male, and 14 (78%) were female. The mean age of the patients was 105.4 ± 44.5(48-184) months. There was no correlation between the vesicoureteral reflux (VUR) grade and age (P = 0.85). The mean VEGF and CD34 scores were 16.2 ± 9.6 (0-90) cells per HPF and 10.2 ± 3.5 (4-16) vessels per HPF in ureters with reflux; these values were 60.6±16.4 (32-84) cells per HPF and 17.8 ± 4.1 (12-24) vessels per HPF in the control group. The amount of VEGF and CD34 were significantly decreased in patients compared with the control group (P < 0.001, P < 0.001).The TGF-?1 levels were significantly higher in patients with VUR compared with the control group (34.2 ± 19.9 vs 5.0±1.9; P=0.001).The amount of VEGF, CD34, and TGF-?1 were not correlated with the grade of reflux (P = 0.26, P = 0.94, and P = 0.42, respectively). Ultrastructural changes in the muscle cells were observed in all the VUR specimens (Grade II-IV).
Refluxing ureters exhibited immune-histopathological abnormalities and ultrastructural changes of the muscle cells in all VUR specimens in the ureterovesical junctions of children treated with failed Dx/HA injec-tions for reflux.
采用免疫组织化学方法和透射电子显微镜（TEM），对接受葡聚糖omer/透明质酸（Dx/HA）注射治疗失败的儿童反流性输尿管膀胱连接部（UVJ）的细胞因子谱和超微结构变化进行了研究。
18例接受反流注射治疗的儿童纳入研究。对输尿管壁的平滑肌排列、转化生长因子-β（TGF-β1）、血管内皮生长因子（VEGF）和CD34进行免疫组织化学评估，并将结果与10例年龄匹配的尸检标本作为对照进行比较。对超微结构进行半定量评估和形态学描述，并与已发表的数据进行比较。
4例患者（22%）为男性，14例（78%）为女性。患者的平均年龄为105.4±44.5（48-184）个月。膀胱输尿管反流（VUR）分级与年龄之间无相关性（P = 0.85）。反流输尿管中VEGF和CD34的平均评分分别为每高倍视野16.2±9.6（0-90）个细胞和每高倍视野10.2±3.5（4-16）个血管；对照组的这些值分别为每高倍视野60.6±16.4（32-84）个细胞和每高倍视野17.8±4.1（12-2）个血管。与对照组相比，患者体内VEGF和CD34的量显著降低（P < 0.001，P < 0.001）。与对照组相比，VUR患者的TGF-β1水平显著更高（34.2±19.9对5.0±1.9；P = 0.001）。VEGF、CD34和TGF-β1的量与反流分级无关（分别为P = 0.26、P = 0.94和P = 0.42）。在所有VUR标本（II-IV级）中均观察到肌肉细胞的超微结构变化。
对于反流性输尿管，在接受Dx/HA注射治疗失败的儿童输尿管膀胱连接部的所有VUR标本中，均表现出免疫组织病理学异常和肌肉细胞的超微结构变化。
