关木通与抗生素致急性肾小管坏死细胞生物学特征的比较研究

作者	单位
杨莉	北京大学第一医院肾内科北京大学肾脏病研究所
李晓玫	北京大学第一医院肾内科北京大学肾脏病研究所
王海燕	北京大学第一医院肾内科北京大学肾脏病研究所

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中文摘要:

目的 :通过比较关木通致急性肾小管坏死 (ManchurianDutchmanspipe acutetubularnecrosis,MD ATN)与抗生素致ATN(antibiotic acutetubularnecrosis ,A ATN)两组病变中肾小管间质细胞表型特征及细胞外基质分泌的异同 ,初步探讨两者预后明显差异的细胞生物学机制。方法 :应用免疫组化SP法观察4例MD ATN和 5例A ATN患者的肾活检组织标本中 ,增殖细胞核抗原 (PCNA)、表皮细胞生长因子(EGF)、α 平滑肌肌动蛋白 (α SMA)、纤维连接蛋白 (FN)、Ⅲ型胶原、Ⅳ型胶原、转化生长因子 β1(TGFβ1)和结缔组织生长因子 (CTGF)表达程度的异同。针对两组患者临床预后的显著差别 ,重点从损伤修复及纤维化发生两个方面对上述指标进行分析。结果 :(1)MD ATN组肾小管上皮细胞 (RTEC)PCNA阳性率以及EGF表达均显著低于A ATN组 (P <0 0 1) ;(2 )两组肾小管间质内α SMA表达均增加 ,差异无显著性 ;(3)两组肾间质内均出现TGFβ1阳性细胞浸润以及CTGF的显著表达 ,两组间比较差异无显著性 ;(4 )MD ATN组肾间质内FN、Ⅲ型和Ⅳ型胶原的表达均较A ATN组明显增加 (P <0 0 1)。结论 :(1)与A ATN组比较 ,MD ATN患者RTEC损伤后自身修复能力减低 ,EGF低表达可能为其修复不良的原因之一。 (2 )MD ATN与A ATN患者肾间质内α SMA、TGFβ1和C

英文摘要:

Objective: To explore the possible cell biological mechanisms of the difference in prognosis between the acute tubular necrosis (ATN) induced by Manchurian Dutchmanspipe (MD ATN) and that by antibiotics (A ATN), by means of comparing their renal tubular mesenchymal cell phenotype characteristics and extra cellular stroma secretion. Methods: The expression of proliferative cell nuclear antigen (PCNA), epithelial cell growth factor (EGF), α smooth muscle actin (α SMA), fibronectin (FN), collagen type Ⅲ and Ⅳ, transforming growth factor β 1 (TGFβ 1) and connective tissue growth factor in renal biopsy samples of patients with MD ATN (4 patients) and A ATN( 5 patients) were compared with immunohistochemical SP method. The analysis of above mentioned parameters on repairing of injury and development of fibrosis was stressed for the obvious difference in clinical prognosis between the two groups. Results: (1)The PCNA positive rate of renal tubular epithelial cell (RTEC) and EGF expression in the MD ATN group were significantly lower than those in the A ATN group respectively (P<0 01); (2) Renal tubular mesenchymal α SMA level increased in both groups with no significant difference; (3) TGFβ 1 positive cell infiltration and obvious CTGF expression revealed in renal mesenchyma of both groups with insignificant difference; (4) FN, collagen Ⅲ and Ⅳ levels were significantly higher in the MD ATN group than that in the A ATN group (P<0 05). Conclusion: (1)As compared withA ATN group, the RTEC auto repairing ability was lower in the DM ATN group, lower expression of EGF might be one of the mechanisms of its poor repair; (2) High expression of α SMA, TGFβ 1 and CTGF presented in all patients with ATN, but extra cellular stromal deposit appeared only in the renal stroma of patients with MD ATN, suggesting that its chronical trend might be related with the reducing of extra cellular stromal degradation factor and/or endogenous anti fibrosis factor.

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