本文選題：腎小球腎炎 + IGA腎病��； 參考：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討IgA腎病(IgAN)患者腎小球微血管損傷情況及中介素(IMD)與IgAN腎小球微血管損傷和修復的相關性。方法:收集于我院腎內科首診為原發(fā)性IgAN患者腎組織蠟塊80例,正常腎組織15例為對照,免疫組織化學法檢測腎小球IMD、CD31、VE-cadherin陽性表達;收集36例首診為原發(fā)性IgAN患者血漿,31例健康體檢中心健康志愿者血漿為對照,ELISA法檢測IMD、VEGF含量,依據Lee氏分級、CKD分期分組,分析各指標的變化情況及相關性。結果:(1)不同Lee氏分級、CKD分期(Lee氏分級5級、CKD分期4期除外),IgAN患者腎小球CD31、IMD、VE-cadherin表達與對照組相比差異具有統(tǒng)計學意義(P0.01),各Lee氏分級、CKD分期腎小球CD31表達較對照組減少,腎小球IMD、VE-cadherin表達增加;CKD早期、中晚期各組IgAN患者血漿中IMD、VEGF含量與對照組相比差異具有統(tǒng)計學意義(P0.01),CKD早期、中晚期各組IMD、VEGF表含量均增加;(2)相關性分析:腎小球CD31表達與Lee氏分級呈負相關(r=-0.232,P0.05),腎小球IMD表達與Lee氏分級呈負相關性(r=-0.241,P0.05),與腎小球VE-cadherin呈正相關(r=0.417,P0.01);IgAN患者血漿VEGF與腎功能不全程度、BUN呈正相關(r=0.458、0.409,P均0.05),與ALB呈負相關(r=-0.532,P0.01)。結論:IgAN患者腎小球存在微血管損傷;IgAN患者腎小球IMD表達與IgAN Lee氏分級呈負相關,腎小球IMD表達隨著IgAN病理程度加重而減少,腎小球IMD表達與VE-cadherin呈正相關,推測IMD在IgAN進展中可能參與血管保護與新生過程;血漿中IMD、VEGF在IgAN晚期增加明顯,提示IMD、VEGF可能在IgAN進展中起到一定作用。
[Abstract]:Objective: to investigate the relationship between glomerular microvascular injury and IgAN glomerular microvascular injury and repair in patients with IgA nephropathy.Methods: 80 cases of primary IgAN and 15 cases of normal renal tissue were collected in our hospital. Immunohistochemical method was used to detect the expression of VE-cadherin in glomeruli.The plasma levels of IgAN were measured by Elisa in 36 patients with primary IgAN and 31 healthy volunteers. The changes and correlation of the indexes were analyzed according to the Lee's classification and CKD stages.Results (1) the expression of VE-cadherin in glomeruli of patients with different Lee's grade and Lee's grade 5 or Lee's grade of CKD with the exception of stage 4 was significantly higher than that of the control group (P 0.01). The expression of CD31 in glomeruli in all Lee's grade and CKD staging was lower than that in the control group, and the expression of VE-cadherin in glomeruli was significantly lower than that in the control group (P < 0.05).The expression of VE-cadherin in glomeruli increased in the early stage of CKD, and there was a significant difference in the level of VEGF in plasma between the middle and late groups of IgAN patients compared with the control group (P 0.01) at the early stage of CKD.Correlation analysis showed that the expression of CD31 in glomeruli was negatively correlated with Lee's grade, IMD expression in glomeruli was negatively correlated with Lee's grade, and was positively correlated with VE-cadherin in glomerular VE-cadherin.Bun was positively correlated with ALB, and negatively correlated with ALB.Conclusion there is a negative correlation between IMD expression and IgAN Lee grade in IgAN patients with glomerular microvascular injury. The expression of IMD in glomeruli decreases with the severity of IgAN. The expression of IMD in glomeruli is positively correlated with VE-cadherin.It is speculated that IMD may participate in the process of vascular protection and neovascularization in the progression of IgAN, and that the level of IMD in plasma is significantly increased in the late stage of IgAN, suggesting that IMD may play a role in the progression of IgAN.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692.31

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