TGF-β1与慢性移植肾肾病关系的临床研究
A clinical investigation about relation between TGF-beta1 in allograft and chronic allograft nephropathy
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摘要: 目的: 探讨移植肾转化生长因子β1(TGF-β1)与慢性移植物肾病的关系。方法: 对152例肾功能正常的肾移植患者检测尿TGFβ1含量,所得相对浓度为157.0~520.7(pg/mg·Cr),分别选出浓度最高和最低的各25例患者构成A组、B组。检测两组血TGF-β1浓度;两组中分别有15例和12例患者进行了移植肾穿剌活检,比较活检组织中TGFβ1mRNA和TGFβ1蛋白的表达;3年后,比较两组肾功能有无差异,对肾功能不全者作移植肾穿剌活检,明确移植肾在病理上是否为非特异性损害(即慢性移植肾肾病的改变)。结果: 两组患者血TGFβ1浓度没有明显差异;A组活检组织中TGF-β1mRNA表达量和TGFβ1免疫荧光强度分别为(1.38±0.28)×106和(10.80±2.31)×106,明显高于B组,后者分别为(0.88±0.25)×106和(6.41±1.57)×106;3年后,A组肌酐清除率(Ccr)为(79.2±11.2)ml/min、有7例患者肾功不全,与B组比较有显著差异;肾功不全的患者,移植肾穿剌活检均证实为慢性移植肾肾病。结论: TGF-β1与慢性移植物肾病的发生有着密切的关联;肾移植后检测尿TGF-β1对远期肾功能具有预测作用。Abstract: Objective: To determine the relation between transforming growth factor beta1(TGF-beta1)in allograft and chronic allograft nephropathy (CAN). Methods: Urine TGF-beta1 relative concentration(divided by urine creatinine)was tested in 152 recipients whose renal function were normal between August 1, 2000 and February 28, 2001. 25 cases with higher urine TGF-beta1 relative concentrations formed group A,and other 25 cases with lower urine TGF-beta1 formed group B. In both groups biopsies were carried out in 15 cases and 12 cases respectively. TGF-beta1mRNA and TGF-beta1 in the biopsis were tested by RT-PCR and immunofluorescence.Blood TGF-beta1 concentrations in the two groups were also tested. Three years later, the renal function was compared between the two groups. Biopsies were carried out in renal recipients whose creatinine is higher than normal.Results: Blood TGF-beta1 concentrations in the two groups were not different significantly; 3 years after transplantation, there was more loss of renal function and more number of chronic allograft nephropathy (CAN) cases in group A than group B. Expression of TGF-beta1mRNA and TGF-beta1 in the allografts is more in group A than in group B. The differences in the two groups were significant.Conclusions: The findings suggest higher expression of TGF-beta1 in the allografts is associated with lower long-term survival rate of kidney graft. The level of urine TGF-beta1 after renal transplantation can predict long-term renal function.
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