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目的探讨抗生素联合皮质激素防治肾盂肾炎延迟治疗时肾皮质瘢痕的效用及机制。方法大鼠分为正常组(A),模型组(B)、左旋氧氟沙星及时治疗组(C)、左旋氧氟沙星加激素延迟治疗组(D)、左旋氧氟沙星延迟治疗组(E),分别于30d、60d、90d测量各组肾小管功能(尿NAG/Cr)、肾功能(Scr、BUN)、24h尿蛋白定量,第90天统计各组肾皮质瘢痕率,RT-PCR及免疫组化测量肾组织TGF-β1mRNA及蛋白水平表达。结果B组第90天出现尿NAG/Cr显著升高,与A、C、D组比较有显著性差异(P﹤0.01);实验期间各组肾功能、24h尿蛋白均无显著差异。C、D组二级及以上瘢痕发生率显著减少(P﹤0.05),D组总体瘢痕率显著减少。RT-PCR及免疫组化提示各组较A组TGF-β1表达增加;相对于B组,C、D组TGF-β1肾内表达显著抑制,E组无此作用。结论延迟治疗时抗生素联合皮质激素有助于减少肾皮质瘢痕发生,单独使用抗生素无此作用。
Objective To investigate the effect and mechanism of antibiotic combined with corticosteroids on prevention and treatment of renal cortical scar during delayed treatment of pyelonephritis. Methods Rats were divided into normal group (A), model group (B), levofloxacin and time-treatment group (C), levofloxacin plus hormone delayed treatment group (D) and levofloxacin delayed treatment group (E). The renal tubular function (urine NAG / Cr), renal function (Scr, BUN) and urinary protein excretion were measured at 30d, 60d and 90d respectively. On the 90th day, PCR and immunohistochemistry were used to detect the expression of TGF-β1 mRNA and protein in renal tissue. Results Urine NAG / Cr increased significantly on the 90th day in group B, which was significantly different from that in groups A, C and D (P <0.01). There was no significant difference in renal function and urine protein among groups during the experiment. The incidences of secondary and above scars in Group C and Group D were significantly decreased (P <0.05), and the overall scar rate in Group D was significantly decreased. RT-PCR and immunohistochemistry suggested that the expression of TGF-β1 in each group was higher than that in group A, while the expression of TGF-β1 in group C and D was significantly inhibited compared with those in group B and group E, respectively. Conclusion Delayed treatment with antibiotics combined with corticosteroids help reduce renal cortical scarring, antibiotics alone did not.