论文标题:CD44在IgA肾病中的表达及临床意义
CD44 Expression in IgA Nephropathy and Its Clinical Implications
论文作者 张燕
论文导师 刘丽秋,论文学位 硕士,论文专业 内科学
论文单位 青岛大学,点击次数 633,论文页数 37页File Size1899k
2003-08-01论文网 http://www.lw23.com/lunwen_136507/ 抗原CD44;IgA肾病;免疫组织化学
Immunogulobulin A (IgA) nephropathy;Antigen CD44 ; Immunohistochemistry
目的 研究CD44在IgA肾病各个病变阶段肾组织中的表达，以及CD44表达与临床指标之间的关系，探讨CD44在IgA肾病发病机理中的生物学意义。方法应用免疫组织化学S-P法检测34例IgA肾病肾组织、6例正常肾组织中的CD44的表达情况，同时测定每位IgA肾病患者的24小时尿蛋白定量、血压、肌酐清除率等。分析不同临床分组、病理分级、有无高血压、蛋白尿程度、血肌酐水平等对CD44表达的影响，分析CD44的表达是否与IgA肾病肾小球、小管间质的损害相关。数据资料以均数±标准差((?)±s)表示；根据资料性质，应用SPSS软件进行X~2检验、等级秩和检验及Spearman等级相关分析，以P＜0.05为检验有显著性差异的标准。结果 在正常肾组织中，CD44在肾小球、肾小管无表达，肾间质可见CD44呈弱阳性表达。CD44在IgA肾病的表达，主要位于严重的系膜增生、新月体、小管间质炎性细胞浸润的部位，CD44表达最强的部位是细胞性新月体。轻度IgA肾病(Ⅰ级)时，肾小球内CD44的表达与正常肾组织相似；中度IgA肾病(Ⅱ级Ⅲ级)时，CD44在。肾小球毛细血管袢、系膜区的染色阳性面积较正常肾组织及轻度IgA肾病CD44明显增加(P＜0.05)；重度IgA肾病(Ⅳ级)时，则CD44在肾小球毛细血管袢及系膜区的表达较正常肾组织更为明显(P＜0.01)，也较轻、中度IgA肾病明显增加(P＜0.05)。随着肾小球硬化的加重，在Ⅴ级IgA肾病时，CD44的表达较Ⅱ级Ⅲ级、Ⅳ级均减少，整个球性硬化时，CD44表达近消失。CD44的表达与蛋白尿的程度存在正相关(r=0.55, P＜0.05)；CD44的表达与血肌酐水平无明显相关性(r=-0.722,P＞0.05)；有高血压组CD44表达阳性率92％(23/25)，无高血压组的阳性表达率为33.3％(3/9)，两者比较有显著性差异(P＜0.01)。CD44在肾组织中的表达与IgA肾病患者的年龄、性别无相关性。结论 1、正常肾组织中，CD44仅在肾间质存在少许表达，提示CD44参与维持组织正常结构的作用。2、IgA肾病随细胞增生的加重及基质的增多，CD44的表达增强，提示CD44与IgA肾病的活动性进展有关。3、CD44的表达与蛋白尿的程度存在正相关，有高血压组CD44表达明显高于无高血压中文摘要组，提示CD44可作为工gA肾病预后不良的指标。4、CD44的表达与肌配清除率水平未发现有相关性，整个球性硬化时，CD44表达近消失，因此CD44可作为判定工gA肾病早期进展的可靠指标。
Objective To research the effects of CD44 on the pathogenesis of IgA nephropathy and clinical implications of CD44, CD44 expression was determined in patients with IgA nephropathy in different stages.Method CD44 expression was detected by immunohistochemical S-P method in 34 specimens from patients with IgA nephropathy, and 6 from controls with normal renal biopsy specimens. Serum creatinine , blood pressure and urinary protein excretion at the time of the renal biopsy were analyzed. SPSS8.0 statistics software were applied to analyze the data.Result Expression of CD44 in renal biopsy of controls was negative in the glomeruli and weakly positive in renal interstitium . In IgA nephropathy, CD44 is expressed in the area of severe mesangial proliferation , cellular crescents and tubulointerstitial inflammatory infiltrate . CD44 is strongly positive in cellular crescents . In IgA nephropathy subclass I , the pattern of CD44 expression is similar to the normal biopsy specism(p > 0.05) .The significant relationship was observed between subclass II , III or Vand subclass I (P<0.05) , between subclass IV and subclass I (P<0.01) . CD44 expression is almost negative in the global sclerotic glomeruli . No significant correlation was found between the expression ofCD44 and the serum creatinine level (r = -0.722, P>0.05). The incidences of CD44 in patientes with high blood pressure were significantly different from those without high blood pressure . CD44 expression correlated significantly with the degree of proteinuria (r =0. 55, P<0. 05 ) .Conclusion Expression of CD44 in normal renal biopsy was negative in the glomeruli and weakly positive in renal interstitium .The glomerular and tubulointerstitial expression of CD44 correlated with the degree of renal damage in IgA nephropathy . No significant correlation was found between the expression of CD44 and the serum creatinine level .The incidences of CD44 in patientes with high blood pressure were significantly different from those without high blood pressure . CD44 expression correlated significantly with the degree of proteinuria .Therefore CD44 could be a reliable marker of the progression of IgA nephropathy . CD44 may have a important role in the cascade of renal inflammation and fibrosis .Postgraduate: ZHANG Yan (Department of nephrology) Directed by: LIU Liqiu
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