尿足细胞及其相关分子在肾小球疾病中的表达

目的：探讨尿液检测局灶节段性肾小球硬化足细胞损伤与其他足细胞病之间的特点和差异。方法：入选原发性局灶节段性肾小球硬化（KSGS）患者54例，膜性肾病（MN）23例及微小病变（MCD）12例，正常对照20例。免疫荧光法计数尿足细胞，荧光实时定量PCR法定量尿沉渣足细胞相关分子nephrin、podocin、synaptopodin mRNA的表达水平，Western印迹法检测尿液WilmsTumor1（WT1）蛋白水平，免疫荧光法检测肾脏组织podocalyxin的表达及分布。结果：（1）FSGS组、MN组、MCD组和对照组尿足细胞阳性率分别是63％、34．8％、33．3％和0，FSGS组与其余各组相比差异均有统计学意义（P〈0．05）。FSGS组足细胞脱落数目显著高于MCD组、MN组和对照组（P〈0．05），伴足细胞尿FSGS患者与不伴足细胞尿FS—GS患者相比，24h尿蛋白和血清白蛋白（Alb）差异均有统计学意义（P〈0．05）。（2）FSGS组尿沉渣足细胞nephrin mRNA表达水平显著高于MCD和MN组（P〈0．05）；FSGS组尿沉渣足细胞podocinmRNA表达显著高于MCD组（P〈0．05），与MN组相比有升高趋势但差异无统计学意义；尿沉渣足细胞synaptopodin mRNA表达各组间差异无统计学意义。尿沉渣足细胞nephrin、podocin．synaptopodin mRNA的表达与24h蛋白尿无相关性。（3）FSGS组尿WT1蛋白量显著高于MCD和MN组。部分足细胞阴性患者尿液检测到WT1分子。（4）FSC-S患者肾组织podocalyxin较对照组、MCD和MN有明显的节段缺失。结论：局灶节段性肾小球硬化病患者足细胞损伤严重，尿足细胞与FSGS疾病活动相关。尿沉渣足细胞nephrin mRNA表达可以把FSGS与MCD和MN区分开来，尿WT1蛋白可能是足细胞早期损伤指标。

Urinary Detection of Podocyte and Associated Molecule in Different Podocyte Diseases

Objective:To detect podocyte injury in the urine of focal segmental glomeruloscleros (FSGS) and other podocyte diseases.Methods:Urinary samples were taken from 54 patients with FSGS,23 with membranous nephropathy(MN) and 12 with minimal-change disease(MCD)and samples from 20 healthy volunteers were served as controls.Freshly voided urine samples were examined by immunofluorescence labeling,using monoclonal antibody against human podocalyxin.Urinary sediment podocyte associated moculars mRNA expression were ...