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目的 :探究免疫球蛋白黏蛋白3(T cell immunoglobulin and mucin 3,Tim-3)在Ig A肾病(Ig A nephropathy,Ig AN)发病过程中的作用及其临床意义。方法:real-time q PCR检测41例Ig AN患者及同期21例健康对照者外周血单个核细胞(peripheral blood mononuclear cells,PBMC)中Tim-3 m RNA表达水平。流式细胞术检测Ig AN患者和健康对照者PBMC中Tim-3阳性细胞比例。记录肾组织活检前24 h尿蛋白定量、尿常规、尿沉渣、镜下红细胞数及血肌酐等临床相关指标。结果:Tim-3 m RNA在Ig AN患者PBMC中表达明显升高(0.64±0.27 vs.0.18±0.09,P<0.01),且随疾病严重程度逐渐增高,Lee氏Ⅲ、Ⅳ、Ⅴ级患者Tim-3 m RNA水平明显高于Ⅰ和Ⅱ级患者,差异有统计学意义(P<0.05);Ig AN患者组PBMC中Tim-3阳性细胞比例显著高于对照组[(1.94±0.77)%vs.(0.59±0.24)%,P<0.01],且随疾病严重程度存在上升趋势,Lee氏Ⅳ、Ⅴ级患者Tim-3阳性细胞比例高于Ⅰ、Ⅱ、Ⅲ级患者,差异有统计学意义(P<0.05);Tim-3 m RNA和Tim-3阳性细胞比例与尿蛋白定量及血肌酐呈显著正相关。结论:Tim-3在Ig AN患者中表达显著上调,并与24 h尿蛋白定量及血肌酐等临床指标相关,提示Tim-3可能参与Ig AN的发生发展过程,并可能成为Ig AN的潜在预后标志物。
Objective: To investigate the role of Tim-3 in the pathogenesis of IgA nephropathy (IgA nephropathy) and its clinical significance. Methods: The expression of Tim-3 mRNA in peripheral blood mononuclear cells (PBMCs) from 41 patients with IgAN and 21 healthy controls were detected by real-time q-PCR. Flow cytometry was used to measure the proportion of Tim-3-positive cells in PBMC from IgAN patients and healthy controls. Urine protein, urinary sediment, urinary sediment, number of erythrocytes under microscope and serum creatinine were recorded 24 hours before renal biopsy. Results: The expression of Tim-3 mRNA in PBMC of patients with Ig AN was significantly higher than that of patients with IgAN (0.64 ± 0.27 vs 0.08 ± 0.09, P <0.01), and gradually increased with the severity of disease. Tim, (P <0.05). The proportion of Tim-3 positive cells in PBMC of patients with Ig AN was significantly higher than that of the control group [(1.94 ± 0.77)% vs (0.59 ± 0.24)%, P <0.01]. With the rising of disease severity, the proportion of Tim-3 positive cells in grades Ⅳ and Ⅴ of Lee patients was significantly higher than that in patients with grades Ⅰ, Ⅱ and Ⅲ (P <0.05). The proportion of Tim-3 mRNA and Tim-3 positive cells was positively correlated with urinary protein and serum creatinine. Conclusion: The expression of Tim-3 in Ig AN patients was significantly up-regulated and correlated with 24-hour urinary proteinuria and serum creatinine, suggesting that Tim-3 might be involved in the pathogenesis of Ig AN and may be a potential prognostic factor for Ig AN landmark.