摘要
目的:探讨IgA肾病(IgAN)患者纤溶酶原激活物(PA)的变化及临床意义。方法:以纤维蛋白平板法检测108例IgAN及34例健康自愿者尿PA活性,同时以免疫组化方法观察了27例IgAN及6例正常人肾组织t-PA、u-PA抗原表达,分析其与临床病理资料的关系。结果:正常人肾组织t-PA偶见少量表达于肾小球毛细血管袢,u-PA则表达于所有节段的肾小管上皮细胞。IgAN肾组织t-PA阳性率及单个肾小球t-PA平均积分明显高于正常人。轻度增殖的肾小球其t-PA阳性率明显增高,中度增殖的肾小球t-PA阳性率明显高于轻度增殖者,硬化肾小球不表达t-PA。u-PA表达明显下调,尿PA活性下降。伴血肌酐升高、肾小管间质病变严重、肾小动脉病变较重或大量蛋白管型形成的患者尿PA活性下降更为明显。结论:IgAN早期肾组织t-PA表达增加,晚期下降。肾组织u-PA表达减少。蛋白管型的形成可能与尿PA活性下调有关。尿PA活性的检测有助于判断IgAN的病情。
Objective To find out the changes of plasminngen activators(PA)in IgA nephropathy(IgAN)and their clinical sig-nificance.Methods In the present study,urinary activity of PA was determined by fibrin plate method.Urine samples were collected from108 patients with IgAN and 34 healthy volunteers.The immunohistochemical study of tissue type PA(t-PA)and urokinase-type PA(u-PA)was carried out,using renal biopsy specimens obstained tom 27 patients with IgAN.The relationships between PA and clinico-pathological features were analysed.Resnlts The t-PA antigen was rarely found in normal renal tissue and weakly distributed along theglomerular capillary walls,but u-PA antigen was strongely present in all segments of the tubular epithelium.In IgAN.the positive rate oft-PA antigen and the average score of t-PA in each glomerulus were higher than those in normal control.The positive rate of t-PAantigen in mild-proliferative glomeruli was significantly higher than that in normal glomeruli.The positive rate of t-PA antigen washigher in middle-proloferative glomeruli than that in mild-proliferative glomeruli.The sclerosis glomeruli did not express t-PA.Theexpression of u-PA antigen in IgAN was much lower than that in normal control.Meanswhile,the activity of PA in urine in IgAN wasalso significantly lower than that in healthy volunteers.The activity of urinary PA was decreased much more in patients with abnormal levelof serum creatinine、serious tubulo-interstitial dernage、obvious renal arteriolar lesion or abundent urinary protein cast in renal tubulethan that in patients without those clinical or pathological features.Conclusion The results suggested that the expression of t-PA antigenincreases in early stage of IgAN and decreases in advanced stage.The expression of u-PA decreases.The formation of urinary protein castin renal tubule may be asssociated with the decrease of urinary PA activity.The determination of urinary PA activity is useful in evaluatingthe state of IgAN.
出处
《福州总医院学报》
2000年第4期3-7,共5页
Journal of Fuzhou General Hospital
