纤维连接蛋白在IgA肾病肾组织内的分布及意义

为了解纤维连接蛋白（Ｆｎ）在ＩｇＡ肾病中的意义，对１０７例ＩｇＡ肾病患者肾组织内Ｆｎ的变化及其与病理和临床的关系进行了观察，发现Ｆｎ分布与系膜增宽程度平行，并在新月体、严重系膜增生及肾小球硬化区明显增多。与单纯系膜区分布者相比，Ｆｎ沿毛细血管襻分布者的病理变化程度、新月体形成、ＩｇＧ、ＩｇＡ及Ｃ３沿肾小球基底膜的沉积，高血压、肾病综合征及非选择性蛋白尿发生率均增高（０．０１＜Ｐ＜０．０５），同时血肌酐清除率下降（０．０１＜Ｐ＜０．０５），２４小时尿蛋白量明显增加（Ｐ＜０．０１）。对４４例的随访表明，Ｂ组慢性肾功能不全的发生率显著高于Ｍ组。结果显示：Ｆｎ在毛细血管襻上的增加反映了系膜增生及毛细血管壁免疫损伤严重程度，并伴有严重的临床表现和不良的预后。

DISTRIBUTION OF FIBRONECTIN IN KIDNEY OF IgA NEPHROPATHY AND ITS CLINICO PATHOLOGICAL CORRELATION

To understand of fibronectin (Fn) distribution in kidney of IgA nephropathy (IgAN) and their meaning, we studied 107 cases of IgAN. Strong positive staining of Fn was shown in mesangial areas with proliferation, crescents, segmental sclerosis, and sclerosing glomeruli. 33 patients (group M) had Fn distributed only in mesangium, and 74 (group B) had Fn along the capillary walls as well as mesangium. Compared with those in group M, patients in group B showed more severe renal histological lesions ( P < 0.01 ), crescent formation and stronger staining of IgG, C 3 ( P <0.05) and IgA ( P <0.01) along the capillary walls. More severe changes of GBM were found in group B under electron microscopy. Clinically, 24h protein excretion ( P <0.01), incidences of hypertension and nonselective proteinuria were significantly higher (0.01< P <0.05), and Ccr was lower (0.01< P <0.05) in group B. 44 patients were followed up for 19.2 months, and the incidence of renal function deterioration in group B increased much more (0.01 < P <0.05) than that in group M. Our results dmonstrated that the increase of Fn along the golmerular capillary walls might reflect that excessive proliferation of mesangial matrix, severe immune injury in capillary wall and damage of GBM, which are correlated with unfavorable clinical features and progression of the disease.