摘要目的 探讨IgA肾病(IgAN)患者肾小球微血管损伤情况及中介素(intermedin,IMD)与血管损伤和修复的相关性.方法 收集山西省人民医院肾内科首诊为IgAN患者肾组织80例及正常肾组织15例,免疫组织化学法检测肾小球IMD、血管内皮细胞标志物血小板-内皮细胞黏附分子(platelet endothelial cell adhesion molecule-1,PECAM-1/CD31)、血管内皮细胞钙依粘连蛋白(vascular endothelial cadherin,VE-cadherin)表达,收集其中36例IgAN患者血浆及31例健康人血浆,ELISA法检测IMD、血管内皮生长因子(VEGF)含量,依据Lee氏分级、CKD分期分组,分析各指标的变化情况及相关性.结果 (1)不同Lee氏分级、CKD分期IgAN患者肾小球CD31、IMD、VE-cadherin表达与对照组相比差异有统计学意义(P＜ 0.01);CKD早期(CKD 1～2期)、中晚期(CKD 3～4期)IgAN患者血浆IMD、VEGF含量与对照组相比差异有统计学意义(P＜0.01).(2)相关性分析:肾小球CD31表达与Lee氏分级呈负相关(r=-0.232,P＜0.05);肾小球IMD表达与Lee氏分级呈负相关(r=-0.241,P＜0.05),与肾小球VE-cadherin呈正相关(r=0.417,P＜0.01);IgAN患者血浆VEGF与CKD分期、BUN呈正相关(r=0.458、0.409,均P＜ 0.05),与ALB呈负相关(r=-0.532,P＜0.01).结论 IgAN患者存在微血管损伤;IgAN患者肾小球IMD与VE-eadherin表达呈正相关,推测IMD在IgAN进展中可能参与血管保护与新生过程,血浆中IMD、VEGF在IgAN晚期增加明显,提示IMD、VEGF可能在IgAN进展中起到一定作用.

abstractsObjective To investigate the glomerular microvascular injury and repair in patients with IgA nephropathy (IgAN) as well as its relationship with intermedin (IMD).Methods Eighty cases of renal tissue taken from patients first diagnosed as IgAN in Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University and 15 cases of normal renal tissue were detected by the expression of glomerular IMD,CD31,and VE-cadherin through immunohistochemical method.ELISA method was used to detect VEGF and IMD of plasm from 31 normal subjects and 36 cases chosen from the IgAN patients.Their changes and internal relationship were analyzed according to Lee's and chronic kidney disease (CKD) classification.Results (1) Compared with the control group the expressions of CD31,IMD,and VE-cadherin in IgAN patients were statistically significant (P ＜0.01).Compared with the control group the levels of IMD and VEGF in plasma of IgAN patients in early stage of CKD group and late stage of CKD group were statistically significant (P ＜ 0.01).(2)Correlation analysis:the expression of glomerular CD31 and Lee's classification were negatively correlated (r=-0.232,P ＜ 0.05);glomerular IMD was negatively correlated with Lee's classification (r=-0.241,P＜0.05),while positively correlated with glomerular VE-cadherin (r=0.417,P＜ 0.01).VEGF in plasma of IgAN patients was positive correlated with CKD classification,BUN (r=0.458,0.409,P＜0.05),and negatively correlated with serum ALB (r=-0.532,P＜0.01).Conclusion Microvascular injury exists in patients with IgAN.The expression of VE-cadherin and IMD are positively correlated,suggesting that IMD may be involved in the progression of vascular protection and angiogenesis in IgAN.The contents of IMD and VEGF in plasma of IgAN patients increase,indicating that they may play a role in the progression of IgAN.