儿童原发性肾病综合征肾组织CD2AP表达与足细胞损伤相关性的初步探讨

目的观察原发性肾病综合征(PNS)患儿肾组织CD2AP蛋白和mRNA的表达,探讨其与足细胞损伤的关系。方法以2012年1月至2013年6月上海市儿童医院收治的PNS且行肾活检的病例为PNS组,以同期我院行泌尿系统肿瘤切除患儿为对照组,取远离肿瘤并病理确认为正常肾组织。PNS组和对照组均行常规切片染色,光镜观察肾脏组织病理改变,电镜观察足细胞的结构变化,分别采用q PCR和免疫组化测定肾组织CD2AP mRNA和蛋白的表达。PNS组CD2AP mRNA表达与血清白蛋白(ALB)、SCr、三酰甘油(TG)、胆固醇(TC)、补体C3、24 h尿蛋白定量和肾小球滤过率(e GFR)行相关性分析。结果 PNS组18例、对照组11例进入分析,两组性别和年龄差异无统计学意义。1PNS组肾组织CD2AP蛋白的表达较对照组降低,(1.302±0.885)vs(2.24±1.18),P0.05,且病理表现为局灶节段性硬化(FSGS)的PNS患儿CD2AP蛋白表达最低。2PNS组肾组织CD2AP mRNA的表达较对照组下调,(0.008 58±0.006 12)vs(0.019±0.012),P0.05。3PNS组肾组织CD2AP mRNA表达与血清TG(r=-0.527,P0.05)、24 h尿蛋白定量(r=-0.602,P0.01)呈负相关,与肾组织CD2AP的蛋白表达呈正相关(r=0.788,P0.01),而与血清Alb、TC、补体C3、GFR和SCr无显著相关性。结论 PNS患儿肾小球足细胞中CD2AP的蛋白和mRNA表达降低,特别是病理表现为FSGS的患儿,可能对足细胞病变的诊断有一定帮助。CD2AP的表达量可能与PNS临床指标相关。

Preliminary discussion on the correlation between podocytes injury and CD2AP expression in children with primary nephrotic syndrome

Objective To observe the CD2AP expression in renal tissue of children with primary nephrotic syndrome(PNS), and to discuss the association between the expression of CD2AP and podocytes injury． Methods Children with PNS after renal biopsy in Shanghai Children′s Hospital from Jan. 2012 to Jun. 2013 were enrolled as PNS group, patients with renal tumor undergone nephrectomy were recruited as control group. Renal pathological change was observed by conventional optical microscopes. Structure of podocyte was observed by electron microscopy. The renal CD2AP mRNA and protein were examined by quantitive real time PCR and immunohistochemistry. Then serum albumin（Alb）,creatinine（Cr）,complement 3（C3）,triglyeride（TG）,cholesterol（TC）,glomerular filtration rate（GFR）and 24-hours proteinuria were detected, simultaneously the relationship between these index and the CD2AP expression was analyzed. Results Eighteen patients were enrolled as PNS group and 11 patients were enrolled as control group. ①Compared to the controls, the expression of CD2AP mRNA decreased significantly in patients with PNS（0.008 58±0.006 12 vs 0.019±0.012, P＜0.05）. ②Compared to the control group, protein expression decreased significantly in PNS group, (1.302±0.885) vs (2.24±1.18), P＜0.05, and children with PNS were the lowest. ③In PNS group, there was moderate correlation between CD2AP mRNA relative expression and TG（r=-0.527，P＜0.05）, 24 h proteinuria（r=-0.602，P＜0.01）, there was strong positive correlation between CD2AP mRNA and protein expressions (r=0.788, P＜0.01). The relationship between CD2AP relative expression and those index such as complement C3, GFR, Cr and TC had no statistic significance. Conclusion The expression of CD2AP in podocyte of PNS cases decreased significantly, especially in those with FSGS. And this change may be correlated with clinical indexes of patients with PNS.