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目的探讨糖尿病性肾病 (diabeticnephropathy ,DIA)病人肾小球足细胞形态及数量的改变与肾功能[主要以血清肌酐浓度 (serumcreatinineconcentration ,SCC)来反应 ]的关系。 方法对 2 2例DIA病人活检标本肾小球足细胞面积与数量的改变作形态定量测定 ;5例因镜下血尿而作肾活检 ,但电镜观察排除其他肾病的标本作为阴性对照(NC)。测定参数 :足细胞面积 ,足细胞面积与肾小球面积比 ,肾小球单位面积足细胞数量 ,肾小球平均面积 ,系膜面积与肾小球面积比 ,肾皮质间质面积比。 结果DIA病人肾小球足细胞面积与数量的定量改变与SCC及肾皮质间质面积比显著相关 ,而对照组无这种关系。 结论在DIA病人 ,肾小球系膜面积的增加与肾间质纤维化的严重程度成正比 ;足细胞相对面积及相对数量的减少与血清肌酐浓度的升高及肾间质纤维化的严重程度成正比。说明在DIA病人 ,不仅肾小球系膜面积的增加与病程的进展密切相关 ,而且足细胞的损伤和丢失也可能起着重要的作用。
Objective To investigate the relationship between the change of morphology and number of glomerular podocyte in patients with diabetic nephropathy (DIA) and renal function [mainly by serum creatinine concentration (SCC)]. Methods The changes of area and number of glomerular podocyte in biopsy specimens of 22 patients with DIA were determined quantitatively. Five patients underwent renal biopsy with microscopic hematuria, but other nephropathy specimens were excluded by electron microscopy as a negative control (NC). Determination of parameters: podocyte area, podocyte area and glomerular area ratio, glomerular per unit area of podocytes, the average area of the glomerulus, mesangial area and glomerular area ratio, renal cortex interstitial area ratio. Results Quantitative changes of area and number of glomerular podocyte in DIA patients were significantly correlated with SCC and interstitial area ratio of renal cortex, but not in control group. Conclusions In DIA patients, the increase in glomerular mesangial area is directly proportional to the severity of renal interstitial fibrosis; the decrease in relative area and relative number of podocytes, the increase in serum creatinine, and the severity of renal interstitial fibrosis Is proportional. This shows that in DIA patients, not only the increase of mesangial area is closely related to the progress of the disease, but also the damage and loss of podocytes may play an important role.