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目的 对血浆型凝溶胶蛋白(pGSN)和纤连蛋白(FN)在糖尿病肾病(DN)患者肾组织的表达及其临床病理学资料进行分析.方法 根据临床诊断,将肾活检诊断为DN的67例患者分为4组:DN或糖尿病(DM)组、DM或DN合并高血压组、DM或DN合并其他肾脏病组和单纯诊断为其他肾脏疾病组,而后者又可分为血糖正常和血糖升高两种.利用免疫组织化学方法检测pGSN和FN在上述组织的石蜡切片的表达情况,与临床资料结合进行统计学分析.结果 pGSN和FN主要表达在肾小球和肾小管中,尤其在纤维化的肾小球和肾小管表达最为明显,两者均与肾小球的硬化率(硬化肾小球/总肾小球数)相关,而与其他的临床指标没有明显相关性.在四组临床诊断分组中,临床DM症状不典型伴有肾脏改变且血糖升高组,其肾小球滤过率(eGFR)明显降低(P＜0.05).而血糖正常组,其凝血酶原时间(PT)、血糖、丙氨酸转氨酶(ALT)、二氧化碳结合力及糖化血红蛋白相较于其他组有统计学意义(P＜0.05).而DM或DN伴有高血压组的患者其凝血项检查中的凝血酶原时间活动度(PT％)、凝血酶原时间国际标准化比值(PTINR)、凝血酶时间(TT)的差异有统计学意义(P＜0.05),ATL、天冬氨酸氨基转移酶(AST)明显降低(P＜0.05).结论 pGSN和FN反映肾小球的纤维化程度.临床上不能明确诊断为DN的病人,肾活检确诊时其肾功能的损害更严重.伴有高血压的DN患者,其凝血系统及肝功发生明显变化.

Objective To detect the expression of plasma gelsolin and fibronectin in diabetic nephropathy and the analysis of clinical pathologic data.Methods 67 cases of patients diagnosed with diabetic nephropathy through renal biopsy were divided into 4 groups according to clinical diagnosis:diabetic nephropathy or diabetes,hypertension with diabetes or with diabetic nephropathy,other renal diseases combined with diabetes or with diabetic nephropathy and simply diagnosed of other kidney diseases,while the last type was further classified into 2 types:normal and high blood glucose.The expression of pGSN and FN were detected using immunohistochemistry method in paraffin section,the clinical data were analyzed.Results pGSN and FN were mainly expressed in glomeruli and renal tubules,especially in the fibrotic ones.Both were associated with the glomerular sclerosis rate (sclerotic glomeruli/total number of glomeruli),which reflects the degree of glomerular fibrosis.This result was not significantly correlated with other clinical indicators.Among the four groups,the eGFR was significantly decreased in untypical diabetic symptoms accompanied with renal changes with high blood glucose (P ＜ 0.05).The PT,blood glucose,ALT,CO2-cp and HbA1c had statistical significance in blood glucose normal group compared with that in other groups (P ＜ 0.05).There were statistical difference in PT％,PTINR and TT of the coagulation test diabetes or diabetic nephropathy with hypertension (P ＜ 0.05).ALT and AST decreased conspicuously (P ＜ 0.05).Conclusion Both pGSN and FN could reflect the glomerular fibrosis rate.Patients that were not definitely diagnosed with diabetic nephropathy in clinic examination,the renal function were more serious which were diagnosed with renal biopsy.The coagulation system and hepatic function were change apparently in diabetic nephropathy patients with hypertension.