尿转化生长因子-β1及Ⅳ型胶原与肾内微型癥积的相关性研究

目的：通过无创检测方法早期发现肾内微型癥积。方法：对98例肾活检的患者进行中医辨证分型；检测血／尿TGF-β1、尿ColⅣ、Scr、Ccr、24h尿蛋白排泄；对肾组织运用CMIAS计算机病理图像分析系统作半定量测定；观察尿TGF-β1、ColⅣ水平，与肾硬化程度、中医辨证间的相关性。结果：（1）肾病患者尿TGF-β1、ColⅣ明显高于健康人（P〈0．01）。（2）尿TGF-β1、ColⅣ与肾小球基质基底膜面密度、肾间质纤维化程度、间质浸润细胞数呈正相关（P〈0．05），与尿ColⅣ呈负相关（P〈0．05）。随着硬化程度加重尿TGF-β1、ColⅣ水平逐级增高。（3）尿TGF-β1、ColⅣ分别与Scr正相关，与Ccr负相关（p〈0．01）；与血TGF-β1、24h尿蛋白定量无关。（4）在轻度肾硬化组，Scr和Ccr尚正常时尿TGF-β1、ColⅣ已高于正常组（P〈0．01），尿ColⅣ敏感程度要高于尿TGF-β1和Ccr。（5）98例肾脏病患者的中医辨证以脾肾气虚型为主，占66．3％，以传统“四诊”辨为兼瘀血证者仅占8例（8．16％），肾硬化均属于重度，肾功能已减退，尿TGF-β1、ColⅣ水平显著高于无瘀血证者。结论：尿TGF-β1、ColⅣ能早于Scr和Ccr的异常反映肾硬化及硬化程度，不受血TGF-β1和24h尿蛋白定量的影响，可以作为监测肾硬化及其进展的一项无创性早期标志性指标，以尿ColⅣ更为敏感；同时揭示肾微癥积的病因为正虚邪郁，中医传统的宏观辨证加上微观辨证可明显提高辨证的准确性，尿TGF-β1、ColⅣ可以作为中医微观辨证的一项量化指标早期诊断肾内微癥积，监测病情的动态变化，指导早期应用消瘕散积中药防治肾硬化。

The Correlation of TGF-β1 ,ColⅣ with Shenwei Zhengji

Objective： To investigate the Urine TGF-β1 and ColⅣ of Patients with SHEN WEI ZHENG JI. Methods： Specimens from renal biopsies of 98 patients by masson staining, with serum/urine level of TGF-β1, urine ColⅣ, serum creatinine, Ccr were examines. Density of matrix membrane, quantity of cell in glomerulus, ratio of interstitial fibrosis and infiltrated cell of interstitial were measured. Senti - quantitative analyses by computer were used to evaluated correlationship among them. Results： （ 1 ） TGF-β1 and ColⅣ in urine of patients were higher than of healthy（P〈0.01 ）. （2）There were positively significant correlation in urine TGF-β1 and ColⅣ with density of matrix membrane, ratio of interstitial fibrosis, infiltrated cell of interstitial （ P 〈 0.05 ）, and negative correlation with urine ColⅣ （P〈 0.05）. （3）There were positively correlation in urine TGF-β1, ColⅣ with serum creati- nine, and negative correlation with Ccr. While no negatively correlation in urine TGF-β1 ColⅣ and serum TGF-β1, urine proteinuria（P〈0.05）. （4）Urine TGF-β1 ,ColⅣ were increased significantly in early glomerulosclerosis. （5）66.3% in patients were featured as Pishenqixu. 8.16% in patients were featured as congestion with higher TGF-β1 and ColⅣ level of in urine. Conclusion： Urine TGF-β1 and ColⅣ measurement can predict glomerulosclerosis without impact of serum TGF-β1 and proteinuria, diagnose early Shenwei Zhengji while ＂Si zhen＂ is delayed to diagnosed, and guide to cure the renal .sclerosis with traditional chinese medicine.