肾小球足细胞损伤与糖尿病性肾病相关性研究

目的 探讨糖尿病性肾病（diabetic nephropathy,DIA)病人肾小球足细胞形态及数量的改变与肾功能[主要以血清肌酐浓度（serum creatinine concentration,SCC)来反应]的关系。方法 对22例DIA病人活检标本肾小球足细胞面积与数量的改变作形态定量测定；5例因镜下血尿而作肾活检，但电镜观察排除其他肾病的标本作为阴性对照（NC）。测定参数：足细胞面积，足细胞面积与肾小球面积，肾小球单位面积足细胞数量，肾小球平均面积，系膜面积与肾小球面积比，肾皮质间质面积比。结果 DIA病人肾小球足细胞与数量的定量改变与SCC及肾波质间质面积比显著相关，而对照组无这种关系。结论 DIA病人，肾小球足细胞面积与增加与肾间质纤维化的严重程度成正比；足细胞相对面积及相对数量的减少与血清肌酐浓度的升高及肾间质纤维化的严重程度成正比。说明在DIA病人，不仅肾小球系膜面积的增加与病程的进展密切相关，而且足细胞的损伤和丢失也可能起着重要的作用。

A Study of Relationship Between Podocyte Damage and Progression of Diabetic Glomerulonephropathy

Objective To investigate relationship between structural and quantitative changes of glomerular podocytes and renal functional parameters (reflected mainly by serum creatinine concentration, SCC) in human diabetic glomerulonephropathy (DIA). Methods The changes of podocytes with their area, number and the relationship of these changes with SCC and interstitial fibrosis were studied in twenty-two cases of human DIA. As negative control (NC) five cases were simultaneously investigated who were biopsied because of microscopic hematouria without any evidence of nephrotic diseaes. The area of the podocytes, the ratio of podocyte cell area to glomerular area, the total number of podocytes per unit glomerular area, the average area of glomeruli, the ratio of area of mesangium to the area of glomerulus and the renal cortical interstitial area were morphometrically determined. Results In DIA significant correlation was found between the morphometric changes of podocyte area and number and SCC and the renal cortical interstitial area. No correlation was found in the NC. Conclusion A direct proportion of increase of mesangial area was found to interstitial fibrosis, so was the decrease of podocyte area and number to increase of SCC and interstitial fibrosis in human DIA. The results indicated that not only the change of mesangium area relates to the severity of disease, but also the injury and loss of podocytes may be a critical factor for the progression of disease in DIA.