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Objective: patients with nephrotic syndrome is often accompanied by podocyte foot processes missing and fusion hole in the diaphragm (slit diaphragm SD) is a protein complex connection podocytes adjacent foot processes, heavy proteinuria with normal foot cell and hole diaphragm structure the destruction of a great relationship. CD2AP (CD2 associated protein CD2AP) is located in the hole in the diaphragm of a protein involved in the assembly of the cytoskeleton, the cell signal transduction and podocyte apoptosis, is an important early indicators of podocyte injury. The Wilm tumor protein 1 (Wilms'tumor 1WT1) in regulation as a transcription factor, sustained expression in the adult podocyte plays an important role in the maintenance of normal podocyte function. In this paper, the method of immunohistochemical detection CD2AP of WT1 expression in adult primary nephrotic syndrome of different pathological types of glomerular and analysis with clinical indicators (such as 24-hour urinary protein excretion, serum creatinine, glomerular sclerosis rate). Methods: (1) primary nephrotic syndrome in 80 patients, average age (39.64 ± 16.3 years), 50 males and 30 females. Glomerular minimal change group (MCN), divided according to the pathological type IgA nephropathy group (focal proliferative sclerosing IgA nephropathy in 8 cases, 11 cases of mild mesangial proliferative IgA nephropathy, severe mesangial proliferative IgA nephropathy case), membranous nephropathy group (Ⅰ MN18 cases, Ⅱ the MN2 patients), focal segmental glomerulosclerosis group (where the top two cases, the umbilical type 2 cases, 16 cases of non-specific), 20 cases in each group. (2) the normal control group of 10 cases of kidney tumor resection tumor remotely normal kidney tissue, 5 males and 5 females. (3) the experimental group and the normal control group before renal biopsy or nephrectomy specimens from urine and serum samples were measured 24 hours urinary protein excretion, serum creatinine, and serum albumin. (4) Northern the Motic Med6.0 image analysis system detected glomerular CD2AP and WT1 expression index (EI), to count light microscope glomerulosclerosis rate (light to endoscopic sclerotherapy glomerular number / glomerular total number of x 100%). (5) clinical indicators with the experimental data with X ± s, CD2AP and WT1 expression in all groups compared using one-way ANOVA, further pairwise comparisons using the SNK method. CD2AP linear correlation analysis between the WT1 and 24 hours urinary protein excretion, serum creatinine, glomerular sclerosis rate. (6) the use of the SPSS16.0 software processing data, p lt; 0.05 represents significant. Results: 1 clinical trials indicators: patients in the control group of 24-hour urinary protein excretion, serum creatinine, respectively: (0.04 ± 0.02g/24h), (of 69.90 ± 5.88umol / L); the tiny glomerular lesions group (MCN), IgA nephropathy group (IgAN), membranous nephropathy group (MN), the group of focal segmental glomerulosclerosis (FSGS), 24-hour urinary protein excretion, respectively: (4.78 ± 1.61 g/24h), (5.55 ± 1.86 g / 24h), (5.70 ± 2.50 g/24h), (4.54 ± 1.63 g/24h); each group of serum creatinine levels (76.43 ± 16.85μmol / L), (82.60 ± 20.4 μmol / L), (78.10 ± 22.46 μmol / L), (123.1 ± 73.29μmol / L); each group hardening rate (3.41 ± 6.22)%, respectively, (2.48 ± 6.01)% (2.51 ± 3.80)% (6.14 ± 11.60)%. Immunohistochemistry results: (1) CD2AP in the control group and the nephrotic syndrome group glomerular and tubular epithelial cells brush border were expressed. Along the capillary walls in the normal control group CD2AP showed a uniform linear distribution. MCN group, MN group, FSGS group CD2AP along the capillary wall is unevenly distributed, finely granular, missing part of the capillary wall expression; CD2AP expression of IgAN group showed intermittent ranging from granular, lack of expression in the area of ??the lesion. CD2AP expression of the control group EI value (14.35 ± 3.29), MCN group, IgAN group, MN group expression of the FSGS group glomerulonephritis CD2AP EI value (11.69 ± 3.36), (11.84 ± 4.37), (7.67 ± 3.06), (8.71 ± 3.06). MN group and FSGS group and the control group significantly lower (p-lt; 0.05); MCN group, of IgAN group and the control group without significantly with differences; the MN group and FSGS group significantly significantly less than the MCN group of IgAN group (p-lt; 0.05). (2) WT1 in glomeruli of the control group was evenly distributed along the capillary wall. The MCN group FSGS group WT1 expression than uniform but the intensity of IgAN group lesion area loss of expression. WT1 in the control group EI value (3.51 ± 0.51), MCN group, IgAN group, MN group, FSGS group of WT1 EI value (2.54 ± 0.85), (2.45 ± 0.57), (3.71 ± 1.08), (1.93 ± 0.31); the MCN group IgA Group, FSGS group with the control group than there are differences (p lt; 0.05), was significantly reduced, while the MN and the control group was not significantly different. No difference between the experimental group (p gt; 0.05). Immunohistochemistry and clinical indicators: primary nephrotic syndrome patients with glomerular the CD2AP the expression level of 24-hour urinary protein excretion negative correlation (r = -0.861, p lt; 0.05), and serum creatinine glomerulosclerosis was no correlation (r values ??were 0.056,0.120, p are gt; 0.05). Glomerular WT1 expression level of 24-hour urinary protein excretion negative correlation (r = -0.304, p lt; 0.05), and serum creatinine, glomerular sclerosis rate no correlation (r values ??were -0.256, -0.316, both p gt; 0.05). Conclusion 1.CD2AP specific expression in glomerular podocytes along the glomerular capillary wall was uniform, linear distribution. Primary nephrotic syndrome CD2AP in glomerular uneven distribution, granular, decreased or absent expression of some areas. MN group and FSGS group and the control group significantly reduce the MCN group, IgAN group and the control group had no significant difference; the MN group and FSGS group was significantly lower than the MCN group, IgAN group. CD2AP expression of 24-hour urinary protein excretion negatively correlated with serum creatinine, glomerular sclerosis was no correlation. 2. WT1 in podocyte nuclei and cytoplasm primary nephrotic syndrome MCN group, IgA group, the FSGS group WT1 expression compared with control group was significantly decreased, and no difference between the groups. MN no significant difference between the control group. Glomerular WT1 expression levels and 24-hour urinary protein excretion negatively correlated with serum creatinine, glomerular sclerosis was no correlation.
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