系膜增生性肾小球肾炎患者Ⅰ型纤溶酶原激活物抑制因子检测及临床意义

目的:探讨Ⅰ型纤溶酶原激活物抑制因子(PAI-1)在系膜增生性肾小球肾炎(MsPGN)中的表达及其病理作用。方法:采用HE、PAS、PASM、Masson及免疫组织化学SABC染色法,对MsPGN56例患者肾活检组织标本进行观察,经计算机医学图像分析系统进行分析。结果:(1)24h尿蛋白定量、白蛋白、甘油三酯、总胆固醇重度系膜增生组均较轻、中度系膜增生组明显升高(均P<0.05);3组间内生肌酐清除率差异无统计学意义。(2)肾小管间质病变与肾功能的关系:无小管间质病变组24h尿蛋白定量、尿α-1微球蛋白、Ccr分别为:1.91±1.12g,296.47±191.25mg/L,122.82±36.59,有小管间质病变组分别为:3.48±1.63g,582.08±291.32mg/L,91.13±42.52,两组3项指标比较差异均有统计学意义(P<0.05)。(3)PAI-1免疫组织化学染色:正常对照组肾小球、肾近曲小管上皮细胞仅呈微弱阳性反应。重度系膜增生组肾小球系膜区PAI-1表达较轻度、中度系膜增生组明显增强(P<0.05),肾小管间质PAI-1表达也明显增强(P<0.05),轻度与中度系膜增生组PAI-1在肾小球系膜区、肾小管间质的表达差异无统计学意义(P>0.05)。结论 :MsPGN病理改变和24h尿蛋白定量、白蛋白、甘油三酯、总胆固醇有一定关系,PAI-1在肾小球与肾间质表达均显著增高,有微血栓存在时则更明显,提示PAI-1在MsPGN发病中具有重要的病理作用。

Expression and Clinical Significance of I-Type Plasminogen Activator Inhibitor(PAI-1) in the Patients with Mesangial Proliferative Glomerulonephritis

Objective:To study the expression of I-Type Plasminogen Activator Inhibitor(PAI-1) in the patients with mesangial proliferative glomerulonephritis(MsPGN) and the role of PAI-1 in the genesis of MsPGN.Method:Histotopathological analysis(HE,PAS,PASM,MASSON) and immunohistochemistry were used to detect the tissues of kidneys of 56 patients with MsPGN,and then computer image analysis system was applied to give analysis.Result:(1) The quantitative of proteinuria in 24 hours and the density of serum albumin,triglyceride and total cholesterol in the severe injury group were statistically significantly higher than those in both the light injury and middle injury groups(P<0.05).Creatinine clearance(CCr) in all of the three groups showed no significant difference.(2) The relation between renal tubulointerstitial pathological injury and renal function: The quantitative of ptoteinuria,the density of urinary α-1 microglobin,and CCr in the group without renal tubulointerstitial pathological injury were 1.91±1.12g,296.47±191.25mg/L and 122.82±36.59ml/min respectively,and those in the group with renal tubulointerstitial pathological injury were 3.48±1.63g,582.08±291.32 mg/L and 91.13±42.52ml/min respectively.Each of these three indexes was statistically different between the two groups(P<0.05).(3) PAI-1 immunohistochemistry staining: The expression of PAI-1 was weakly detected in the glomerulus and the renal proximal tubule epithelial cells of the normal group.The expression of PAI-1 in the mesangial area of the severe injury group strengthened drastically than that of the light injury and middle injury groups(P<0.05),and so did the expression of PAI-1 in renal interstitium(P<0.05).The expression of PAI-1 in the mesangial area and the renal interstitium showed no statistically difference between the light injury and middle injury groups(P>0.05).Conclusion:There is a certain correlation between the pathological injury and clinical manifestations including the quantitative of ptoteinuria in 24 hours,the density of serum albumin,triglyceride and total cholesterol,CCr in the patients with MsPGN.The expression of PAI-1 was strengthened drastically in glomerulus and renal interstitium,particularly in those accompanied by microthrombus.Therefore PAI-1 may play an important role in the pathological genesis of MsPGN.