Objective:To observe the expression of ICAM - 1, VCAM - 1 and Thrombomodulin ( TM ) in different clinico-pathologic type of HBV - GN, and study their effect on the progress of HBV - GN. Methods: The clinical and pathological data of 68 patients was retrospectively analyzed, who were diagnosed as HBV - GN by renal biopsy. The protein expression of ICAM - 1, VCAM - 1 and TM in renal biopsy specimens were determined by immunohistochemistry. The relationship between the expression of those proteins and the degree the clinical and pathologic changes was . analyzed. Results: The expression of ICAM - 1 in glomerular and per-itubular capillaries of HBV - GN was no significant difference as compared with the control group. The expression of ICAM - 1 and VCAM - 1 in renal tubules were significantly higher than the normal control group, and significantly different among different pathological types of HBV - GN. The expression of TM in peritubular capillaries of HBV - GN patients ( SGN excluded ) was not obviously increased as compared to the control group. In comparison with the control group and other pathology, the expression of TM in SGN group was significantly lower. As the extent of tubulointerstitial lesions increased, ICAM - 1 and VCAM - 1 began to increased gradually, while at most in the severe lesions ( P <0.05 ). TM is the opposite. The expression of ICAM - 1 and VCAM - 1 was positively correlated to the lesion degree of renal tubulointerstitium. The expression of TM was negatively correlated to the lesion degree of renal tubulointerstitium. Conclusion:The expression of ICAM - 1 and VCAM - 1 were increased in renal tubular of HBV - GN, inducing infiltration of mononuclear macrophages. ICAM - 1 and VCAM - 1 may lead to renal tubular immunopathological injury and progression of disease. The expression of TM in renal tissue could not fully reflect the extent of damage of vascular endothelial cells.%目的:观察细胞间黏附分子-1(ICAM-1)、血管细胞黏附分子-1(VCAM-1)和血栓调节蛋白(TM)在HBV-GN不同临床病理类型中的表达特点,研究它们在HBV-GN进展中的作用.方法:回顾性分析68例HBV-GN患者的临床病理资料,采用免疫组化方法检测肾活检组织中ICAM-1、VCAM-1和TM的表达情况,分析其变化与临床病理指标的关系.结果:ICAM-l在HBV-GN肾小球和肾小管周围毛细血管有较强的表达,与正常对照组相比无明显差异.而ICAM-l和VCAM-1在肾小管上的表达均明显高于正常对照组.且不同病理类型中ICAM-l和VCAM-1在肾小管上的表达有明显差异.TM在增生硬化型(SGN)组肾小管周围毛细血管的表达较正常对照组及其他各种病理类型表达下调.随着肾小管间质病变程度的加重,ICAM-1和VCAM-1的表达则逐渐增加,则在重度病变组表达最多(P<0.05),TM则相反.肾小管上ICAM-1和VCAM-1的表达与肾小管间质病变评分呈正相关.TM的表达与肾小管间质病变评分呈负相关.结论:ICAM-1和VCAM-1在HBV-GN患者肾小管的表达增加,诱导单核巨噬细胞浸润,可能是导致肾小管免疫病理损伤而促进疾病进展的重要发病机制.肾组织中TM表达不能完全反映血管内皮细胞受损的程度.
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