本文選題：慢性腎臟病 + α-SMA��； 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：慢性腎臟病（Chronic Kidney Disease, CKD）的發(fā)病率已經(jīng)逐年上升，尤其是在發(fā)達(dá)國家。已經(jīng)嚴(yán)重影響了人們的生存質(zhì)量。而CKD最終發(fā)展為終末期腎�。‥nd stage renal disease， ESRD）以后需要的維持治療以及并發(fā)癥的治療導(dǎo)致昂貴的醫(yī)療費用，終末期腎病對人生存質(zhì)量也有著巨大的影響。慢性腎臟病是發(fā)生心血管事件的高危因素，而心血管事件又是CKD的最主要的死亡原因。有研究表明，心血管并發(fā)癥占終末期腎病死亡原因的50%。頸動脈內(nèi)膜增厚是心血管疾病發(fā)生的一個窗口，對頸動脈內(nèi)膜厚度的監(jiān)測，可以直觀的預(yù)測心血管事件的發(fā)生。正常人腎組織內(nèi)小動脈中膜有豐富的α-SMA的表達(dá)，中膜內(nèi)膜化是CVD及CKD血管重塑的基本病變，也是CKD發(fā)生CVD的基礎(chǔ)。而在慢性腎臟病患者動脈中層發(fā)生嚴(yán)重鈣化時其表達(dá)會明顯減少。本實驗主要研究各期CKD患者腎內(nèi)小動脈α-SMA的表達(dá)程度的差異，腎內(nèi)小動脈α-SMA的表達(dá)程度與頸動脈內(nèi)膜厚度的關(guān)系以及腎間質(zhì)α-SMA的表達(dá)陽性程度與腎間質(zhì)損傷程度的關(guān)系，揭示腎組織α-SMA的表達(dá)與腎組織病變程度的關(guān)系并通過腎活檢時檢測腎組織α-SMA的陽性程度來預(yù)測心血管事件。 方法：選取2012年3月至2012年9月在河北醫(yī)科大學(xué)第二醫(yī)院住院行腎活檢明確腎臟病理改變的患者63例。按照eGFR分為3組，CKD1期病人26例，CKD2期病人21例，CKD3期病人13例，CKD4期病人3例，行腎活檢后腎組織用FAA固定液固定，包埋后以2um厚度連續(xù)切片，行PAS染色，PASM染色以及免疫組化染色，觀察腎間質(zhì)纖維化程度、腎內(nèi)小動脈以及腎間質(zhì)α-SMA的表達(dá)程度，應(yīng)用PAS染色以及PASM染色結(jié)果判斷腎間質(zhì)病變程度，連續(xù)的觀察50個高倍鏡視野，觀察腎小管腔有無擴張、萎縮、變性，腎間質(zhì)有無炎性細(xì)胞浸潤及腎間質(zhì)纖維化程度，將腎小管病變程度分4級。組化染色在同一時間同一條件下進(jìn)行。光鏡下觀察每張標(biāo)本染色結(jié)果，免疫組化結(jié)果按照腎小管胞漿以及小動脈壁上出現(xiàn)棕黃色顆�；驂K狀沉積為陽性結(jié)果，并在高倍鏡下觀察，選取5個陽性結(jié)果區(qū)域進(jìn)行圖像分析，得出陽性面積以及累積光密度值，計算后得出平均陽性面積百分比以及平均光密度值，以此作為腎組織α-SMA表達(dá)陽性程度的定量結(jié)果。 結(jié)果：1腎內(nèi)小動脈α-SMA的平均光密度：CKD1期組0.2816±0.0161；CKD2期組0.2681±0.0990；CKD3期組0.2172±0.0512，CKD4期組0.1916±0.0301,腎內(nèi)小動脈α-SMA平均陽性面積百分比：CKD1期組22.2301±6.3452%；CKD2期組19.1032±9.3423%；CKD3期組14.3401±12.3427%，CKD4期組10.4049±11.6902%：各組之間兩兩比較均有統(tǒng)計學(xué)差異(P＜0.05）。 2腎間質(zhì)α-SMA的平均光密度: CKD1期組0.0231±0.3252；CKD2期組0.1631±0.4962；CKD3期組0.2117±0.5162，CKD4期組0.3016±0.3901.腎間質(zhì)平均陽性面積百分比: CKD1期組2.9041±1.1002%；CKD2期組4.3079±1.6201%；CKD3期組13.5078±1.2504%，CKD4期組20.3016±0.9061%各組之間兩兩比較均有統(tǒng)計學(xué)差異(P＜0.05） 3頸動脈內(nèi)膜厚度：CKD1期組患者0.5021±0.0401mm；CKD2期組0.5137±0.1042mm； CKD3期組0.8147±0.1016mm； CKD4期組1.1047±0.1106mm。CKD1期組患者與CKD2期組患者比較IMT變化無統(tǒng)計學(xué)意義，CKD1期組與CKD3期組CKD4期組各組之間兩兩比較均有統(tǒng)計學(xué)差異(P＜0.05）。CKD2期組與CKD3期組CKD4期組各組之間兩兩比較均有統(tǒng)計學(xué)差異(P＜0.05）。 4腎內(nèi)小動脈α-SMA平均陽性面積百分比與肌酐、血壓、血鉀、cIMT呈負(fù)相關(guān)關(guān)系，與Co2結(jié)合力、TG、TC呈正相關(guān)關(guān)系(P＜0.05）；腎間質(zhì)平均陽性面積百分比與肌酐、血壓、血鉀、cIMT呈正相關(guān)關(guān)系，與Co2結(jié)合力、TG、TC呈負(fù)相關(guān)關(guān)系(P＜0.05） 結(jié)論：腎組織α-SMA的表達(dá)的變化可能參與了CKD的發(fā)生發(fā)展。聯(lián)合檢測腎內(nèi)小動脈以及腎間質(zhì)α-SMA的表達(dá)程度與頸動脈內(nèi)膜厚度的關(guān)系可為CKD患者發(fā)生心血管意外的可能性提供一定的依據(jù)。
[Abstract]:Objective: the incidence of Chronic Kidney Disease (CKD) has increased year by year, especially in developed countries. It has seriously affected people's quality of life. And CKD eventually developed for end-stage renal disease (End stage renal disease, ESRD) after the maintenance of treatment and the treatment of complications resulting in expensive medical costs, End-stage renal disease also has a huge impact on the quality of life. Chronic kidney disease is a high risk factor for the occurrence of cardiovascular events and cardiovascular events are the most important cause of death in CKD. Studies have shown that the 50%. carotid artery thickening is a window of cardiovascular disease in the cause of the death of end-stage renal disease. The monitoring of carotid artery intima thickness can directly predict the occurrence of cardiovascular events. The membrane of the small arteries in the normal human renal tissue is rich in the expression of alpha -SMA. Middle membrane intima is the basic lesion of CVD and CKD vascular remodeling and the basis of CVD in the occurrence of CKD. The difference in the expression of alpha -SMA in renal arterioles of CKD patients at various stages, the relationship between the expression of alpha -SMA and the thickness of carotid artery intima as well as the relationship between the expression of the renal interstitial alpha -SMA and the degree of renal interstitial injury, and the expression of the renal tissue alpha -SMA and the degree of renal tissue lesion in the renal tissue were investigated. The cardiovascular events were predicted by detecting the positive level of alpha -SMA in renal tissue by renal biopsy.
Methods: from March 2012 to September 2012, 63 patients with renal pathological changes in the second hospital of Hebei Medical University were selected. According to eGFR, they were divided into 3 groups, 26 cases in stage CKD1, 21 in CKD2 stage, 13 in phase CKD3 and 3 in CKD4 stage. After renal biopsy, the renal tissue was fixed by FAA fixation, and the thickness of 2um was continuous after embedding. Sections, PAS staining, PASM staining and immunohistochemical staining were used to observe the degree of renal interstitial fibrosis, renal arterioles and the expression of renal interstitial alpha -SMA. PAS staining and PASM staining were used to determine the degree of renal interstitial lesions. 50 high magnification fields were observed continuously, and whether the renal tubules were dilated, atrophic, denatured, and renal interstitium were observed. The degree of inflammatory cell infiltration and renal interstitial fibrosis was divided into 4 levels. The histochemical staining was carried out at the same time on the same condition. The results of each specimen were observed under the light microscope. The results of immunohistochemical staining were positive according to the brown yellow particles or lump deposits on the renal tubules and the wall of the arteriole, and under high magnification. The positive area and the cumulative light density value were obtained from 5 positive results regions, and the average positive area percentage and the mean light density were calculated as a quantitative result of the positive degree of the expression of the renal tissue alpha -SMA.
Results: 1 the mean light density of alpha -SMA in the intrarenal arteriole was 0.2816 + 0.0161 in the CKD1 phase group and 0.2681 + 0.0990 in the CKD2 phase group, 0.2172 + 0.0512 in the CKD3 stage and 0.1916 in the CKD4 stage, and the average positive area of the alpha -SMA in the renal arteriole: the CKD1 stage group was 22.2301 + 22.2301, CKD2 phase group 19.1032 + 9.3423%, CKD3 phase group 14.3401 + CKD4, CKD4. The period group was 10.4049 + 11.6902%: there was a significant difference between 22 groups (P < 0.05).
Mean optical density of 2 renal interstitial alpha -SMA: CKD1 phase group 0.0231 + 0.3252, CKD2 stage group 0.1631 + 0.4962, CKD3 stage group 0.2117 + 0.5162, CKD4 stage group 0.3016 + 0.3901. mean renal interstitial mean positive area percentage: CKD1 phase group 2.9041 + 1.1002%, CKD2 phase group 4.3079 + 1.6201%, CKD3 group 13.5078 + 1.2504%, CKD4 period group between each group There were statistical differences between 22 (P < 0.05).
3 carotid artery intima thickness: the CKD1 group was 0.5021 + 0.0401mm, the CKD2 group was 0.5137 + 0.1042mm, the CKD3 group was 0.8147 + 0.1016mm, and the 1.1047 + 0.1106mm.CKD1 phase group in the CKD4 group and the CKD2 group compared with the CKD2 group, and the IMT changes were not statistically significant. There was a statistically significant difference between the CKD1 phase and the CKD3 group. 0.05) there were significant differences between the 22 groups in the.CKD2 group and the CKD3 stage CKD4 group (P < 0.05).
4 the average positive area percentage of alpha -SMA in renal arterioles was negatively correlated with creatinine, blood pressure, blood potassium and cIMT, and positive correlation with Co2 binding force, TG and TC (P < 0.05). The percentage of mean positive area of renal interstitium was positively correlated with creatinine, blood pressure, potassium and cIMT, and negative correlation with Co2 binding force, TG and TC (P < 0.05).
Conclusion: the changes in the expression of the renal tissue alpha -SMA may be involved in the development of CKD. The relationship between the renal arteriole and the expression of the renal interstitial alpha -SMA and the thickness of the carotid artery intima can provide a certain basis for the possibility of cardiovascular accident in the patients with CKD.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692

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本文編號：1884070