摘要
目的探讨早期慢性肾脏病（CKD）患者肾组织甲状旁腺激素（PTH）表达和分布，以及其在CKD进展中的可能作用。方法选取2009年至2012年间本科收治并经肾活检确诊的CKD1期及2期的肾小球肾炎患者82例为研究对象。另取8例肾移植配型不符或肾肿瘤患者的正常肾组织作对照。受试者均检测Scr、BUN、血钙、磷、PTH及25（OH）VitD3等。以Cockcroft—GauIt（CG）公式计算肌酐清除率（Ccr），双血浆^99mTc—DTPA清除率法检测GFR。根据肾间质炎性细胞浸润程度，将患者分为轻、中、重组，用免疫组化方法观察。肾组织PTH表达和分布；用Image—ProPlus图像分析软件计算各例肾组织PTH阳性染色吸光度（A）值，并比较PTH表达强度差异。结果CKD1期及2期的肾小球。肾炎患者的外周血钙、磷、25（OH）VitD3及PTH水平均处于正常范围，PTH与上述其他指标间无相关。不同病理类型肾小球肾炎患者肾组织均可见PTH表达，主要位于肾小管，而肾小球及肾间质也有少量分布，其表达强度均显著高于对照组（P〈0．01），且随肾间质炎性细胞浸润增多，PTH表达增强。各病理类型间肾组织胛H表达强度差异无统计学意义。结论早期CKD（1期及2期）患者肾组织PTH表达增强，且早于外周血PTH的改变及矿物质和骨代谢紊乱，可能与局部炎性反应程度相关。
Objective To investigate the expression and distribution of parathyroid hormone （PTH） in renal tissues of early stage chronic kidney disease （CKD）, and to elucidate its potential role in renal lesion. Methods Eighty- two patients of early stage CKD （stage 1 and 2） diagnosed as glomerulonephritis （GN） with different pathologic types by renal biopsy in our department between 2009 and 2012 were enrolled in the study. Renal tissues of eight patients with mismatched HLA haplotype or the normal part of renal cancer were chosen as controls. Scr, BUN, serum calcium, phosphorus, PTH and 25（OH）VitD3 were measured. Creatinine clearance （Ccr） was calculated by Coekeroft-Gault （CG） formula. ^99mTc-DTPA clearance rate was used to detect GFR. Patients were divided into mild, moderate and severe groups according to the renal interstitial extent of inflammatory cells infiltration. Immunohistoehemistry was used to observe the expression and distribution of PTH in renal tissues. Image-Pro Plus software was used to calculate A value of PTH in renal tissues and compare the extent of PTH expression. Results The levels of calcium, phosphorus, 25（OH）VitD3 and PTH in peripheral blood from GN patients of CKD stage 1 and 2 were normal. PTH had no correlation with the above indexes. PTH expression could be seen in renal tissues of all the GN patients with different pathologic types, and it mainly located in renal tubular, only a few in glomeruli and interstitium. The expression of PTH in renal tissues of GN increased compared with the controls （P 〈 0.01）. Furthermore, PTH expression elevated with the increase of inflammatory cells infiltration in interstitium. However the expression of PTH was not significantly different among different pathologic types of GN. Conclusions In the early stage CKD, PTH expression in patients of GN increases, which occurs earlier as compared to PTH elevation in peripheral blood and the imbalance of minerals and bone metabolism. The intensity of PTH expression is associated with the local inflammation.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2012年第12期922-926,共5页
Chinese Journal of Nephrology
关键词
肾疾病
甲状旁腺激素
炎症
早期慢性肾脏病
Kidney disease
Parathyroid hormone
Inflammation
Early stage chronic kidney disease
