IgA肾病患者纤溶酶原激活物的变化及临床意义

为探讨IgA肾病 (IgAN)患者纤溶酶原激活物 (PA)的变化及临床意义 ,以纤维蛋白平板法检测 10 8例IgAN及 36例健康自愿者尿PA活性 ,以免疫组化方法观察了 2 7例IgAN及 6例正常人肾组织t PA、u PA抗原表达。结果显示 ,正常人肾组织t PA少量表达于肾小球毛细血管袢 ,u PA表达于所有节段的肾小管上皮细胞。IgAN肾组织t PA阳性率及肾小球t PA平均积分明显高于正常人 (P <0 0 1) ,与其增殖程度有关。IgAN患者u PA表达明显下调 ,尿PA活性下降 ,肾小管间质病变严重者尿PA活性下降更为明显。本研究表明 ,IgAN早期肾组织t PA表达增加 ,晚期下降 ;u PA表达减少 ;尿PA活性的检测有助于判断IgAN的病情。

THE CHANGES IN PLASMINOGEN ACTIVATORS IN PATIENTS WITH IgA NEPHROPATHY AND THEIR CLINICAL SIGNIFICANCE

To investigate the changes in plasminogen activators (PA)in IgA nephropathy(IgAN).Urinary activity of PA was determined by fibrin plate method. Urine samples were collected from 108 patients with IgAN and 34 healthy volunteers.Immunohistochemical study of tissue-type PA (t-PA) and urokinase-type PA(u-PA) was carried out in 27 patients with IgAN and 6 normal renal transplant donators.The results showed that the expression of t-PA antigen was rarely found in normal renal tissue,but u-PA antigen was strongely expressed in all segments of the tubular epithelium.In IgAN, the positive rate of t-PA antigen and the average score of t-PA in glomerulus were higher than those in normal controls(positive rate 88 89% VS 16 67%, P<0 01 ).The positive rate of t-PA antigen in glomeruli was associated with the degree of its proliferation.The expression of u-PA antigen in IgAN decreased significantly.Meanswhile,the activity of PA in urine in IgAN was also significantly lower than that in healthy volunteers,and this change was more obvious in patients with serious tubulo-interstitial demage.The results suggested that the expression of t-PA antigen in the kidney increased in the early stage of IgAN and decreased in the advanced stage. Meanwhile the expression of u-PA decreased.The determination of urinary PA activity is useful in evaluating the state of IgAN.