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目的:探讨Ⅰ型纤溶酶原激活物抑制因子(PAI-1)在系膜增生性肾小球肾炎(MsPGN)中的表达及其病理作用。方法:采用HE、PAS、PASM、Masson及免疫组织化学SABC染色法,对MsPGN56例患者肾活检组织标本进行观察,经计算机医学图像分析系统进行分析。结果:(1)24h尿蛋白定量、白蛋白、甘油三酯、总胆固醇重度系膜增生组均较轻、中度系膜增生组明显升高(均P<0.05);3组间内生肌酐清除率差异无统计学意义。(2)肾小管间质病变与肾功能的关系:无小管间质病变组24h尿蛋白定量、尿α-1微球蛋白、Ccr分别为:1.91±1.12g,296.47±191.25mg/L,122.82±36.59,有小管间质病变组分别为:3.48±1.63g,582.08±291.32mg/L,91.13±42.52,两组3项指标比较差异均有统计学意义(P<0.05)。(3)PAI-1免疫组织化学染色:正常对照组肾小球、肾近曲小管上皮细胞仅呈微弱阳性反应。重度系膜增生组肾小球系膜区PAI-1表达较轻度、中度系膜增生组明显增强(P<0.05),肾小管间质PAI-1表达也明显增强(P<0.05),轻度与中度系膜增生组PAI-1在肾小球系膜区、肾小管间质的表达差异无统计学意义(P>0.05)。结论 :MsPGN病理改变和24h尿蛋白定量、白蛋白、甘油三酯、总胆固醇有一定关系,PAI-1在肾小球与肾间质表达均显著增高,有微血栓存在时则更明显,提示PAI-1在MsPGN发病中具有重要的病理作用。
Objective: To investigate the expression and pathological role of type Ⅰ plasminogen activator inhibitor (PAI-1) in mesangial proliferative glomerulonephritis (MsPGN). Methods: The renal biopsy specimens from 56 cases of MsPGN were observed by HE, PAS, PASM, Masson and immunohistochemical SABC staining and analyzed by computer medical image analysis system. Results: (1) 24h urinary protein, albumin, triglycerides, severe total mesangial hyperplasia group were lighter, moderate mesangial proliferation group was significantly higher (all P <0.05); endogenous creatinine No significant difference in clearance rate. (2) The relationship between tubulointerstitial lesions and renal function: In the tubulointerstitial group, urinary protein excretion and urinary α-1 microglobulin, Ccr were 1.91 ± 1.12g, 296.47 ± 191.25mg / L, 122.82 ± 36.59, and there were 3.48 ± 1.63g, 582.08 ± 291.32mg / L and 91.13 ± 42.52 in tubulointerstitial lesion group. There were significant differences in the three indexes between the two groups (P <0.05). (3) PAI-1 immunohistochemical staining: glomerular and renal proximal tubule epithelial cells in normal control group showed only a weak positive reaction. The expression of PAI-1 in glomerular mesangial area of severe mesangial hyperplasia group was milder than that of moderate mesangial hyperplasia group (P <0.05), and the expression of PAI-1 in tubulointerstitial was also significantly increased (P <0.05) The expression of PAI-1 in glomerular mesangial area and tubulointerstitium in mild and moderate mesangial proliferative group had no statistical significance (P> 0.05). Conclusion: The pathological changes of MsPGN are related to the quantitation of 24-hour urinary protein, albumin, triglyceride and total cholesterol. The expression of PAI-1 in both glomerulus and renal interstitium is significantly increased, while the presence of microthrombus is more obvious PAI-1 has an important pathological role in the pathogenesis of MsPGN.