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目的 :研究结缔组织生长因子 (connectivetissuegrowthfactor,CTGF)在原发性肾小球肾炎小管间质病变中的表达及其与肾间质纤维化之间的关系。 方法 :选择不同类型原发性肾小球肾炎患者 42例 ,根据小管间质病变分级分为四组 :0级 8例 ,1级 12例 ,2级 12例 ,3级 10例。应用免疫组织化学方法分别观察四组中CTGF、TGF β1、FN和COL Ⅲ的表达 ,并将CTGF表达水平与患者血肌酐 (SCr)和内生肌酐清除率 (Ccr)进行比较。 结果 :肾小管上皮细胞 (从近端小管到髓质集合管 )是间质中CTGF的主要来源 ,CTGF表达量与肾小管间质病变程度成正比 (P=0 0 0 5 )。此外 ,CTGF与TGF β1、FN和COL Ⅲ的表达量成正相关 (P均 <0 0 5 ) ;与患者Ccr升高水平成正比 (P <0 0 0 5 )。 结论 :随着慢性肾小管间质病变程度加重 ,CTGF蛋白质分子表达量显著增加 ,它可能在肾间质纤维化形成过程中起重要作用。CTGF作为TGF β1的下游因子 ,可能通过促进细胞外基质 (ECM)如FN和COL Ⅲ等合成增加 ,参与肾间质纤维化发生。
Objective: To investigate the expression of connective tissue growth factor (CTGF) in tubulointerstitial lesions of primary glomerulonephritis and its relationship with renal interstitial fibrosis. Methods: Forty-two patients with different types of primary glomerulonephritis were divided into four groups according to the grade of tubulointerstitial lesion: grade 0 in 8 cases, grade 1 in 12, grade 2 in 12, and grade 3 in 10. The expression of CTGF, TGFβ1, FN and COL Ⅲ in the four groups were observed by immunohistochemistry. The expression of CTGF was compared with the levels of serum creatinine (SCr) and endogenous creatinine (Ccr) in the four groups. Results: Tubular epithelial cells (proximal tubules to medullary tubules) were the main source of CTGF in the interstitium. The expression of CTGF was proportional to the degree of tubulointerstitial lesions (P = 0.0060). In addition, CTGF was positively correlated with the expression of TGFβ1, FN and COL Ⅲ (all P <0.05), and positively correlated with the elevated level of Ccr (P <0.05). CONCLUSIONS: As the severity of tubulointerstitial lesions increases, the expression of CTGF protein molecules increases significantly, which may play an important role in the formation of renal interstitial fibrosis. As a downstream factor of TGFβ1, CTGF may participate in the development of renal interstitial fibrosis by increasing the synthesis of extracellular matrix (ECM) such as FN and COL Ⅲ.