摘要
目的探讨成人起病微小病变肾病(MCD)的血管病变与足细胞排泄的关系。方法入选2005年10月至2007年10月在同济大学附属第十人民医院肾脏科住院经肾穿刺活检确诊为微小病变的患者21例。根据肾穿刺病理结果,将这些患者分为有血管病变(8例)与无血管病变两组(13例),比较足细胞排泄及其与致血管病变的临床病症关系。结果伴血管病变患者尿足细胞排泄水平与肌酐比值或占尿上皮细胞中的构成比均高于无血管病变组患者(P<0.05);同时伴血管病变患者尿上皮细胞显著高于无血管病变组(P=0.018)。伴血管病变组患者体重指数(BMI)、年龄和三酰甘油均显著高于无血管病变组(P<0.05),而平均动脉压、血尿、总胆固醇、高密度脂蛋白、低密度脂蛋白及肝功能指标差异无统计学意义(P>0.05)。伴血管病变患者GFR[(83.1±13.9)mL/min对(123.0±16.9)mL/min,P=0.016]和Cystatin C[(1.12±0.16)g/L对(0.631±0.08)g/L,P=0.012]显著降低,而α1-微球蛋白、微量白蛋白、N-乙酰-β-D葡萄糖苷酶(NAG)、肌酐、尿素氮等指标和肾脏病理损伤差异无统计学意义(P>0.05)。相关性分析发现,足细胞排泄与BMI、年龄和三酰甘油无相关关系,但尿上皮细胞排泄与年龄呈正相关(P=0.014,r=0.616),年龄与血液三酰甘油呈正相关关系(P=0.01,r=0.64)。结论尿足细胞排泄与成人起病MCD的血管病变有关;年龄相关的代谢异常是成人起病MCD患者血管病变的危险因素。
Objective To investigate the relationship between vascular damage and urine podocyte excretion in adult-onset minimal change disease （ MCD ）. Methods （ 1 ） Twenty-one patients with adult-onset MCD proven by renal biopsy were enrolled, 13 female and 8 male ,with an average age of 41 years. （2）These patients were divided into two groups, with（ n = 8 ）or without（ n = 13 ）vascular damages, based on their renal biopsy findings. The clinical indexes of these patients were observed and analyzed. （ 3 ） Urine podocyte excretion level was calculated by the counting from urinary sediment smear. Results （ 1 ） The MCD patients with vascular damages had a higher level of urinary podoeyte/urine croatinine, percentage of podoeyte in urine epithelial cells and urine epithelial cell excretion （ P 〈 0. 05 ）. （ 2 ） The age, body mass index（ BMI） and blood triglyceride level were significantly increased in the patients with vascular damages（ P 〈 0. 05 ） , while other clinical characteristics such as blood pressure, haematuria, edema, liver function and blood cholesterol, HDL and LDL levels had no significant differenee（P 〉 0. 05）. （3）The GFR [ （83.1 ± 13.9）mL/min vs（ 123 ± 16.9） mL/min,P = 0. 016] was significantly increased in the MCD patients with vascular damages, while Cystatin C decreased [ （ 1.12 ± 0. 16 ） g/L vs （ 0.631 ± 0. 08 ） g/L, P = 0. 012 ]. The changes of BUN, SCr, SCr -MG, microalbuminuria, NAG-enzyme had no significant difference between two groups. （4）The relationship between urine podocyte excretion and metabolism index such as the BMI, age, and blood triglyceride was not observed. But the positive relationship between the age and blood triglyceride level（P =0. 01 ,r=0. 64）as well as urinary epithelial cells exeretion（P=0. 014,r =0. 616） was found. Conclusion Chronic vascular damages of patients with adultonset MCD contribute to urine podocyte excretion. The age, blood triglyceride and BMI are related to vascular damages of adult-onset MCD.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2008年第9期732-735,共4页
Chinese Journal of Practical Internal Medicine
基金
上海市自然科学基金(06ZR14161)
中国博士后基金(2004350118)
关键词
微小病变肾病
血管病变
足细胞
minimal change disease
vascular damage
podocyte
