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目的观察不同病理类型、不同激素反应性肾病综合征(NS)患者肾小球足细胞中podocin的表达和分布特征。方法肾组织作冰冻切片免疫荧光双染色。以激光共聚焦显微镜采集图像。与定位标志Ⅳ型胶原α3链比较。受检NS患者21例。其中局灶节段性肾小球硬化(FSGS)12例(难治性7例,非难治性5例)、微小病变(MCD)5例、膜性肾病(MN)4例;正常肾组织对照3例。采用LSM510图像处理系统进行处理。荧光强度以吸光度表示。结果(1)podocin在正常肾组织沿肾小球基底膜呈连续、线形分布。部分FSGS患者podocin的分布呈点状、短线条状,少数患者未见podocin沉积。(2)FSGS患者肾小球中podocin表达量(80.5±33.5)与对照正常肾组织(138.4±38.1)比较,显著减少(P=0.0211),其中难治性FSGS(67.2±30.5)与正常肾组织的差异有统计学意义(P=0.0131);非难治性FSGS患者(99.0±31.0)与正常肾组织的差异无统计学意义(P=0.1585)。(3)MCD(112.1±47.6)、MN(92.5±34.8)患者podocin的表达量亦降低,与正常肾组织比较,无统计学意义(P=0.4497,P=0.1570)。(4)不同病理类型各组NS患者肾小球中podocin表达量的差异均无统计学意义(P>0.05)。结论FSGS的NS患者肾小球中podocin的表达减少,难治性FSGS患者尤为明显,部分FSGS患者podocin分布发生改变。podocin的检测可能在FSGS激素疗效评价方面有一定价值。
Objective To observe the expression and distribution of podocin in glomerular podocytes of patients with different pathological types and different hormone-responsive nephrotic syndromes (NS). Methods Renal tissue sections were immunofluorescence double staining. Confocal laser scanning microscope image acquisition. And positioning marker type Ⅳ collagen α3 chain comparison. Twenty-one NS patients were tested. There were 12 cases of focal segmental glomerulosclerosis (FSGS), 7 cases were refractory (5 cases), 5 cases were minimal change (MCD) and 4 cases were membranous nephropathy (MN). The control group 3 cases. LSM510 image processing system for processing. Fluorescence intensity is expressed as absorbance. Results (1) podocin in normal kidney tissue along the glomerular basement membrane was continuous and linear distribution. Some FSGS patients podocin distribution was dotted, short-term stripe, a small number of patients without podocin deposition. (2) The expression of podocin in the glomeruli of FSGS patients (80.5 ± 33.5) was significantly lower than that in the control normal kidney tissues (138.4 ± 38.1) (P = 0.0211) (P = 0.0131). There was no significant difference between the non-refractory FSGS patients (99.0 ± 31.0) and normal renal tissues (P = 0.1585). (3) The expression of podocin in MCD (112.1 ± 47.6) and MN (92.5 ± 34.8) patients was also lower than that in normal renal tissues (P = 0.4497, P = 0.1570). (4) There was no significant difference in the expression of podocin in glomerulus among NS patients with different pathological types (P> 0.05). Conclusion The expression of podocin in the glomeruli of NS patients with FSGS is decreased, especially in patients with refractory FSGS. The distribution of podocin in some patients with FSGS is changed. The detection of podocin may be of some value in the evaluation of hormonal effects of FSGS.