特发性肺纤维化患者血清结缔组织生长因子和纤维连接蛋白水平研究

目的研究特发性肺间质纤维化（IPF）患者血清结缔组织生长因子（CTGF）和纤维连接蛋白（Fn）水平及其与肺纤维化严重程度的关系。方法用临床-影像-生理（CTa）评分系统评价IPF患者肺纤维化严重程度,并分为高分组和低分组,用酶联免疫吸附试验（ELISA）测定IPF组（n=44）和键康对照组（n=44）的血清CTGF和Fn水平,用WilCoxon秩和检验比较各组间CrGF、Fn水平差异,用Spearman秩相关分析CRP分数与CTGF、Fn之间的相关性。结果高分组与对照组比较,血清CrGF和Fn水平增高（P〈0．05）;低分组与对照组比较,血清CrGF和Fn水平无差异（P〉0．05）;高分组CRP分数与血清CTGF及Fn之间的秧相关数分别为0．52和0．45,即它们之间呈正相关。结论肺纤维化程度较重的IPF患者血清CTGF、Fn水平增高。且随肺纤维化严重程度而增加。     

日本血吸虫病小鼠肝纤维化肝脏CTGF、TGF-β1的表达及意义

目的 研究结缔组织生长因子（connective tissue growth factor，CTGF）与转化生长因子β1（transforming growth factor-betal，TGF-β1）在日本血吸虫病小鼠肝纤维化肝脏中的表达状况及意义。方法 用昆明小鼠感染尾蚴建立日本血吸虫病小鼠肝纤维化模型，随机分为模型组和对照组，感染后6、10、14、18周杀鼠；HE染色观察肝脏病理变化，免疫组化法检测肝内CTGF、TGF-β1蛋白的表达水平。结果 模型组小鼠10周时形成血吸虫病肝纤维化，此时肝内CTGF表达达高峰。且10、14、18周时的表达量均显著高于同期对照组（P〈0．01）；模型组TGF-β1蛋白定量和CT—GF有相同的变化趋势，但18周时与同期对照组比较差异无显著性（P〉0．05）；模型组CTGF和TGF-β1蛋白表达水平具有直线相关性。结论 CTGF与TGF-β1的表达与日木血吸虫病小鼠肝纤维化形成有密切关系，TGF-β1的致纤维化作用可能部分通过CTGF的生物学作用介导，阻断CTGF的传导通路可能是血吸虫病肝纤维化治疗的有效靶点。     

日本血吸虫病肝纤维化小鼠肝脏CTGF、TGFβ_1-mRNA的表达及意义

目的研究结缔组织生长因子(connective tissue growth factor,CTGF)mRNA与转化生长因子-β1(transforminggrowth factor-beta1,TGFβ-1)mRNA在日本血吸虫病肝纤维化小鼠肝脏中的表达及意义。方法用昆明小鼠感染尾蚴复制小鼠日本血吸虫病肝纤维化模型,模型组分别在6、10、14、18周杀鼠,治疗组在6周时予吡喹酮治疗后10、14、18周杀鼠;masson染色并图像分析进行胶原半定量;RT-PCR检测小鼠肝脏CTGFmRNA、TGFβ-1mRNA表达。结果模型组10周时小鼠血吸虫病肝纤维化形成,胶原量进行性增加,肝脏CTGFmRNA表达达高峰,10周、14周、18周时与治疗组相比均有明显的统计学差异(P均<0.01);模型组TGFβ-1mRNA表达水平和CTGFmRNA有相同的变化趋势,但18周时与治疗组已无明显差别(P>0.05);模型组CTGFmRNA和TGF-β1mRNA的表达具有直线相关性。结论CTGF与TGF-β1的基因表达与小鼠日本血吸虫病肝纤维化形成有密切关系;TGF-β1的致纤维化作用可能部分通过CTGF的生物学作用介导;通过阻断CTGF的传导通路可能是肝纤维化治疗的有效靶点。     

Clinical significance of connective tissue growth factor in hepatitis B virus-induced hepatic fibrosis

AIM: To determine the utility of connective tissue growth factor (CCN2/CTGF) for assessing hepatic fibrosis in hepatitis B virus (HBV)-induced chronic liver diseases (CLD-B).METHODS: Enzyme-linked immunosorbent assay was used to measure CCN2 in sera from 107 patients with chronic hepatitis B (CHB) and 39 patients with HBV-induced active liver cirrhosis and 30 healthy individuals. Liver samples from 31 patients with CHB, 8 patients with HBV-induced liver cirrhosis and 8 HBV carriers with normal liver histology were examined for transforming growth factor β-1 (TGF-β1) or CCN2 mRNA levels by in situ hybridization, and computer image analysis was performed to measure integrated optimal density (IOD) of CCN2 mRNA-positive cells in liver tissues. Histological inflammation grading and fibrosis staging were evaluated by H and E staining and Van Gieson’s method.RESULTS: Serum CCN2 concentrations were, respectively, 4.0- or 4.9-fold higher in patients with CHB or active liver cirrhosis as compared to healthy individuals (P < 0.01). There was good consistency between the levels of CCN2 in sera and CCN2 mRNA expression in liver tissues (r = 0.87, P < 0.01). The levels of CCN2 in sera were increased with the enhancement of histological fibrosis staging in patients with CLD-B (r = 0.85, P < 0.01). Serum CCN2 was a reliable marker for the assessment of liver fibrosis, with areas under the receiver operating characteristic (ROC) curves (AUC) of 0.94 or 0.85 for, respectively, distinguishing normal liver controls from patients with F1 stage liver fibrosis or discriminating between mild and significant fibrosis.CONCLUSION: Detection of serum CCN2 in patients with CLD-B may have clinical significance for assessment of severity of hepatic fibrosis.     

结缔组织生长因子在肾间质纤维化中的表达及其意义

目的 :研究结缔组织生长因子 (connectivetissuegrowthfactor,CTGF)在原发性肾小球肾炎小管间质病变中的表达及其与肾间质纤维化之间的关系。　 方法 :选择不同类型原发性肾小球肾炎患者 42例 ,根据小管间质病变分级分为四组 :0级 8例 ,1级 12例 ,2级 12例 ,3级 10例。应用免疫组织化学方法分别观察四组中CTGF、TGF β1、FN和COL Ⅲ的表达 ,并将CTGF表达水平与患者血肌酐 (SCr)和内生肌酐清除率 (Ccr)进行比较。　 结果 :肾小管上皮细胞 (从近端小管到髓质集合管 )是间质中CTGF的主要来源 ,CTGF表达量与肾小管间质病变程度成正比 (P=0 0 0 5 )。此外 ,CTGF与TGF β1、FN和COL Ⅲ的表达量成正相关 (P均 <0 0 5 ) ;与患者Ccr升高水平成正比 (P <0 0 0 5 )。　 结论 :随着慢性肾小管间质病变程度加重 ,CTGF蛋白质分子表达量显著增加 ,它可能在肾间质纤维化形成过程中起重要作用。CTGF作为TGF β1的下游因子 ,可能通过促进细胞外基质 (ECM)如FN和COL Ⅲ等合成增加 ,参与肾间质纤维化发生。     

结缔组织生长因子在大鼠肝纤维化形成中的作用

目的 研究结缔组织生长因子（CTGF）在大鼠肝纤维化形成中的表达及作用机制。方法 雄性SD大鼠32只,体重250～300g,皮下注射四氯化碳（CCl4）制备大鼠肝纤维化模型,分别于注射后1、4、8周处理动物．采用免疫组化、RT—PCR等方法对肝组织中CTGF的表达进行检测。结果 CCl4注射诱导后,大鼠肝组织中CTGF的表达较正常对照明显增强（P〈0．01）．且注射1、4、8周组肝组织中CTGF的表达强度呈逐级递增的趋势（P〈0．01,〈0．05）。CTGF主要表达于肝星状细胞胞质中．CTGF mRNA的表达与其蛋白质水平的改变相一致。结论 CTGF作为一种致纤维化因子,其过表达促进肝星状细胞的活化增殖及细胞外基质的形成,从而促进了大鼠肝纤维化的发生、发展。     

Connective tissue growth factor: a fibrogenic master switch in fibrotic liver diseases

Connective tissue growth factor (CTGF=CCN2), one of six members of cysteine‐rich, secreted, heparin‐binding proteins with a modular structure, is recognized as an important player in fibrogenic pathways as deduced from findings in non‐hepatic tissues and emerging results from liver fibrosis. Collectively, the data show strongly increased expression in fibrosing tissues and transforming growth factor (TGF‐β)‐stimulated expression in hepatocytes, biliary epithelial cells and stellate cells. Functional activity as a mediator of fibre–fibre, fibre–matrix and matrix–matrix interactions, as an enhancer of profibrogenic TGF‐β and several secondary effects owing to TGF‐β enhancement, and as a down‐modulator of the bioactivity of bone morphogenetic protein‐7 has been proposed. By changing the activity ratio of TGF‐β to its antagonist bone‐morphogenetic protein‐7, CTGF is proposed as a fibrogenic master switch for epithelial–mesenchymal transition. Consequently, knockdown of CTGF considerably attenuates experimental liver fibrosis. The spill‐over of CTGF from the liver into the blood stream proposes this protein as a non‐invasive reporter of TGF‐β bioactivity in this organ. Indeed, CTGF‐levels in sera correlate significantly with fibrogenic activity. The data suggest CTGF as a multifaceted regulatory protein in fibrosis, which offers important translational aspects for diagnosis and follow‐up of hepatic fibrogenesis and as a target for therapeutic interventions. In addition, CTGF‐promoter polymorphism might be of importance as a prognostic genetic marker to predict the progression of fibrosis.     

抗结缔组织生长因子小分子干扰RNA防治大鼠肝纤维化研究

目的探讨经门静脉注射抗结缔组织生长因子(CTGF)小分子干扰RNA(siRNA)是否能在体内抑制大鼠肝CTGF基因表达及防治大鼠肝纤维化。方法雄性SD大鼠24只,均分成4组,模型组皮下注射40%CCl4(3ml/kg)及门静脉注射生理盐水,每3d1次,连续6周;预防组皮下注射CCl4及门静脉注射抗CTGFsiRNA(0.1mg/kg),每3d1次,连续6周;治疗组皮下注射CCl42周,随后再给予抗CTGFsiRNA及CCl44周;对照组门静脉注射生理盐水6周。于最后1次CCl4注射后3d行门静脉测压,并取血及组织标本,检测血清转氨酶、透明质酸(HA)及Ⅲ型前胶原(PⅢNP)浓度,应用RTPCR及Western印迹法检测CTGFmRNA及蛋白质在大鼠肝组织表达,应用HE及Siriusred胶原染色检测肝组织炎症及纤维化,应用偏光扫描对肝组织胶原染色面积进行定量。结果与模型组相比,预防组及治疗组大鼠肝组织CTGFmRNA及蛋白质表达显著下调,肝组织炎症、坏死及纤维化明显减轻,血清转氨酶、HA及PⅢNP浓度显著降低;预防组、模型组和治疗组的肝组织胶原染色面积分别为5.8%±0.8%、12.3%±0.8%和7.2%±0.9%(P<0.01);门静脉压力分别为(14.2±2.3)cmH2O、(20.6±5.8)cmH2O和(15.1±3.6)cmH2O(P<0.05),明显降低。结论经门静脉注射抗CTGFsiRNA能在体内显著抑制大鼠肝CTGF基因表达并能有效防治大鼠肝纤维化,提示抗CTGFsiRNA有潜力成为防治肝纤维化的一种新策略。     

Identification of paraxanthine as the most potent caffeine‐derived inhibitor of connective tissue growth factor expression in liver parenchymal cells

Background: Recently, we identified hepatocytes as the major cellular source of profibrogenic connective tissue growth factor (CTGF/CCN2) in the liver. Based on reports of a hepatoprotective effect of coffee consumption, we were the first to provide evidence that caffeine suppresses transforming growth factor (TGF)‐β dependent and ‐independent CTGF expression in hepatocytes in vitro and in vivo, thus suggesting this xanthine‐alkaloid as a potential therapeutic agent. Aim: This study aims at comparing the inhibitory capacities of caffeine and its three demethylated derivates paraxanthine, theophylline and theobromine on CTGF expression in hepatocytes and hepatic stellate cells (HSC). Results: Our data suggest paraxanthine as the most important pharmacological repressor of hepatocellular CTGF expression among the caffeine‐derived metabolic methylxanthines with an inhibitory dosage (ID)₅₀ of 1.15 mM, i.e. 3.84‐fold lower than what is observed for caffeine. In addition, paraxanthine displayed the least cell toxicity as proven by the water‐soluble tetrazolium‐1 cell vitality assay. However, caffeine or any of the metabolites did not inhibit CTGF expression in HSC. At the toxicological threshold concentration of 1 mM for paraxanthine, we observed an inhibition of hepatocellular CTGF synthesis by 44%, which was strongly reverted in the presence of the specific competitive cyclic adenosine monophosphate inhibitor Rp‐adenosine 3′,5‐cyclic monophosphorothioate triethylammonium salt. Furthermore, CTGF protein expression induced by various concentrations of TGF‐β (0.13–1 ng/ml) is still reduced by, on average, 27%/45% in the presence of paraxanthine (1.25 mM/2.5 mM). Conclusion: Our data provide an evidence‐based suggestion of the caffeine‐derived primary metabolite paraxanthine as a potentially powerful antifibrotic drug by its inhibitory effect on (hepatocellular) CTGF synthesis.     

结缔组织生长因子在慢性乙型肝炎和肝硬化中的表达研究

探讨结缔组织生长因子(CTGF)的肝内表达与肝炎肝硬化的关系。62例慢性乙肝或肝炎肝硬化的肝组织活检标本,采用免疫组化进行CTGF肝内表达研究。肝炎肝硬化患者CTGF的肝内表达明显高于慢性乙肝患者(P<0．01),慢性乙肝炎性活动期患者CTGF的表达高于非活动期患者(P<0．05)。CTGF的表达主要集中于汇管区和纤维化区,肝星状细胞、成纤维细胞和窦状隙内皮细胞染色常呈阳性。CTGF的表达与肝硬化密切相关,肝细胞的炎性活动可加强CTGF的表达。肝星状细胞、成纤维细胞和窦状隙内皮细胞是肝内CTGF的重要来源。     

Soluble CCN2/connective tissue growth factor levels in Egyptian systemic sclerosis patients: Possible association with cutaneous and pulmonary fibrosis

Aim of the workTo assess plasma levels of CCN2 in systemic sclerosis (SSc) patients and study its relation with the disease characteristics.Patients and methodsPlasma from 59 Egyptian patients with SSc (19 diffuse and 40 limited subtype) and 50 healthy controls were assayed for CCN2 levels by Enzyme-Linked Immunosorbent Assay (ELISA). Skin fibrosis was assessed using the modified Rodnan total skin thickness score (mRTSS).ResultsThe mean age of patients was 39.4 ± 11.8 years (19–69 years), 41 females/18 males with mean disease duration of 6.6 ± 5.3 years. mRTSS was 13.1 ± 5.5 (median 12; range 3–28). Plasma CCN2 were significantly higher in patients with diffuse subtype (3296.2 ± 1540.5 pg/ml) than those with limited SSc (1984.4 ± 1174.1 pg/ml) (p = 0.001) and controls (1878.5 ± 501.2 pg/ml) (p = 0.78). In addition, plasma CCN-2 levels were increased in SSc patients with interstitial pulmonary fibrosis (2836.5 ± 1614.4 and 1861.6 ± 925.6 pg/ml, respectively; p = 0.04), in patients with early SSc than those with late (2843.1 ± 1586.7 and 2128.2 ± 1265.8 pg/ml respectively; p = 0.03). Patients with mRTSS ≥ 12 had higher CNN2 levels than those with lower scores (2783.6 ± 270.1 and 1842.9 ± 907.4 p = 0.03). CCN2 levels significantly correlated with mRTSS (r = 0.4, p = 0.002) and negatively with DLco (r = −0.39, P = 0.003) and FVC % (r = −0.38, r = 0.003). There was no significant relation to other organs involvement or to the presence of autoantibodies.ConclusionThe work indicates the importance of CCN2 in cutaneous and pulmonary fibrosis in patients with SSc especially those with diffuse subtype. An additional prospective large scale, a longitudinal study should be carried out to support these findings and to reveal the mechanistic connections between CCN-2 levels and SSc disease manifestations.     

糖尿病大鼠肾脏纤维化与CTGF表达的相关性

目的 探讨糖尿病大鼠肾脏纤维化与结缔组织生长因子（CTGF）表达的关系.方法 应用腹腔注射链脲佐菌素（STZ）的方法诱导糖尿病大鼠模型,共成功造模23只,其中18只按照饲养时间随机分为3组;4周（n=6）、12周（n=6）、24周（n=6）],同时设置18只大鼠作为对照组,分别饲养4周（n=6）,12周（n=6）和24周（n=6）,在相应时间点采用免疫组织化学法检测肾脏CTGF含量,同时进行肾脏病理检测并进行组间比较.结果 糖尿病模型组CTGF蛋白表达在各时间点,随病程的进展,表达逐渐增高.第4周分别为（0.88±0.05）×10^3/μm^2vs.（0.41±0.06）×10^3/μm^2第12周分别为（0.29±0.05）×10^3/μm^2vs.（0.60±0.05）×10^3/μm^2第24周分别为（3.13±0.08）×10^3/μm^2vs.（1.50±0.05）×10^3/μm^2差异均有统计学意义（P＜0.05）.且CTGF的含量与肾脏间质血管周围胶原面积（PVCA）（r=0.89）、肾小球胶原沉积评分（GCDS）（r=0.87）、肾小管间质病变评分（TIDS）（r=0.76）、肾小球系膜基质指数（Ms/Gs）（r=0.82）（P＜0.05）均呈正相关.结论 糖尿病大鼠CTGF的高表达,可能与肾脏纤维化有关,检测肾脏CTGF含量可考虑作为评价肾脏纤维化的方法.     

大鼠结缔组织生长因子部分cDNA序列的克隆及其mRNA在实验性 …

目的 克隆出大鼠结缔组织生长因子（ｃｏｎｎｅｃｔｉｖｅ ｔｉｓｓｕｅ ｇｒｏｗｔｈ ＣＴＧＦ）的部分ｃＤＮＡ序列,并观察在实验性肝经大鼠肝脏中ＣＴＧＦ ｍＲＮＡ的表达改变。方法 根据小鼠ＣＴＧＦ ｍＲＮＡ序列设计引物,用ＲＴ－ＰＣＲ从大鼠肝脏总ＲＮＡ中扩增出一段４３０ｂｐ的产物,并测定其序列,将１６只雌性Ｗｉｓｔａｒ大鼠随机为胆管堵塞组（ｎ＝８）及假手术组（ｎ＝８）,６周后取大鼠提取总ＲＮＡ,利用     

反义抑制结缔组织生长因子对实验性肝纤维化的影响

目的观察结缔组织生长因子(CTGF)反义RNA对实验性肝纤维化的影响。方法应用分子生物学技术构建CTGF反义RNA真核表达质粒,经腹腔注射入CCl4诱导的肝纤维化模型大鼠体内;通过RT-PCR、Western blot及免疫组织化学等方法检测CTGF反义RNA基因转染前后CTGF mRNA和蛋白质在肝组织中含量的变化;并通过检测肝组织中Ⅰ、Ⅲ型胶原含量的变化,观察CTGF反义RNA对大鼠肝纤维化的影响。结果转染CTGF反义RNA后,可抑制CTGF mRNA和蛋白质的表达(P<0.01),减少Ⅰ、Ⅲ型胶原的沉积(P<0.01),并在一定程度上促进肝组织的改善(P<0.01)。结论CTGF反义RNA对肝纤维化有一定的治疗作用。     

A simple,noninvasive test for the diagnosis of liver fibrosis in patients with hepatitis C recurrence after liver transplantation

Summary. Recurrent hepatitis C is a common cause of graft loss in patients undergoing liver transplantation, and serial protocol liver biopsies have been used to identify patients at risk of graft loss from rapid fibrosis progression. The aim of this study was to derive a simple noninvasive index to predict fibrosis in patients with recurrent hepatitis C post‐transplant. A retrospective study was performed assessing serial liver biopsies for post‐transplant chronic hepatitis C infection. One hundred eighty‐five patients were included in the analysis; median age 53 years (interquartile range 48–59) and 140 (76%) were male. Liver histology showed 53 (29%) had Ishak fibrosis stages F0/F1, 31 (17%) had F2, 29 (16%) had F3, 19 (10%) had F4 and 53 (29%) had F5/F6. The London Transplant Centres’ (LTC) score was derived combining aspartate aminotransferase (AST IU/L), time from liver transplant (TFLT months), international normalized ratio and platelets. Diagnostic accuracy of the LTC score was assessed using area under receiver‐operating characteristic (ROC) curves. The area under the ROC curve for moderate fibrosis (F ≥ 2) was 0.78 (95% CI, 0.70–0.86; P < 0.0001), for advanced fibrosis (F4–6) was 0.80 (95% CI, 0.72–0.87; P < 0.0001) and for cirrhosis was 0.80 (95% CI, 0.72–0.88; P < 0.0001). An optimal cut‐off value of 6.3 distinguished patients with no or mild fibrosis (F ≤ 1) odds ratio 10.8 (95% CI, 5.1–22.9); P < 0.0001), sensitivity 88%, specificity 60%, negative predictive value 67% and positive predictive value 84%. The LTC score can identify patients with Hepatitis C virus recurrence following liver transplant with a low risk of significant fibrosis, thus avoiding the need for protocol biopsy.     

Smad泛素化调节因子2在肝纤维化过程中对结缔组织生长因子的作用研究

目的:在体内和体外研究Smad泛素化调节因子2(Smurf2)在肝纤维化过程中对结缔组织生长因子(CTGF)的作用。方法:建立四氯化碳诱导肝纤维化大鼠模型,收集人类肝硬化和正常肝组织样本,用逆转录-聚合酶链反应(RT-PCR)、蛋白质印迹(Western blot,WB)、免疫组织化学(IHC)方法检测Smurf2和CTGF的表达;培养人类肝星状细胞(LX-2),构建Smurf2表达质粒和小干扰RNA(siRNA),在转化生长因子β1(TGF-β1)作用后,通过WB检测Smurf2过表达和小干扰后对CTGF表达的影响。结果:在大鼠肝纤维化时,Smurf2表达增加,伴有CTGF水平增高;大鼠和人类肝硬化组织中,Smurf2表达反而减少,CTGF表达仍然增加。体外肝星状细胞用TGF-β1处理后,CTGF蛋白水平升高;过表达Smurf2可以阻断CTGF蛋白的合成;抑制Smurf2表达后,CTGF表达持续增加。TGF-β1处理LX-2后可以诱导Smurf2表达内源性轻度增加。结论:Smurf2可以由TGF-β1诱导产生,作为负反馈抑制子抑制肝纤维化过程中CTGF表达的增加。     

肾脏结缔组织生长因子的检测及其对糖尿病肾病早期诊断的价值

目的探讨结缔组织生长因子（CTGF）在糖尿病（DM）患者肾组织中以及尿中的检测对早期诊断糖尿病肾脏损害的意义。方法40例DM患者根据尿白蛋白排泄率（UAER）分为正常白蛋白尿（N-UAlb）组（〈20μg／min，15例）、微量白蛋白尿（M-UAlb）组（20～200μg／min，13例）和大量白蛋白（L-UAlb）尿组（〉200μg／min，12例）。双抗体夹心ELISA法检测尿中CTGF的浓度，其中20例行肾活检，免疫组织化学技术检测肾组织中CTGF的表达，并与30例正常对照（NC）组进行比较。结果CTGF在正常肾组织中无或仅有基础量表达，随着DM肾脏损害的加重，表达逐步增强；与NC组相比，DM患者尿CTGF排泄在正常白蛋白尿组已显著升高（P〈0．01），且随着UAER增加其水平亦呈逐渐递增趋势，组间比较差异有统计学意义（P〈0．01）。相关分析表明：尿CTGF与UAER及之间呈显著正相关（P〈0．01），与肌酐清除率呈负相关（P〈0．01）。结论CTGF在糖尿病肾病（DN）的发生发展中起着重要作用。测定DM患者尿CTGF的含量，不仅可作为诊断DN早期肾损害较敏感的指标，还将有助于监测、判断DN的病程进展。