| Objective To investigate the relationship between clinical manifestation and pathomorphological types in IgA nephropathy(IgAN) of Shanxi provice and to investigate the interaction of transforming growth factorβ1,hepatocyte growth factor and some index of clinial and pathologicin this diseasMethods (1)Collected the positive diagnosis of primary IgAN was made after renal biopsies in The Sencond Affiliated Hospital of Shanxi Medical College 446 patients form january 2001to december 2007 ,divied to 2001-01/2004-12,2005,2006 and 2007 four stages for analyzing the relationship between the clinical features and pathomorphological types.(2)Collected the positive diagnosis of primary IgAN was made after renal biopsies in The Sencond Affiliated Hospital of Shanxi Medical College 76 patients from april to october in 2008 .All the renal biopsies were stained routinely by hematoxylin and eosin,p-aminosalicylic acid,periodic acid-sliver methenamine and Masson.According to features under the microscope divided into mild mesangial proliferative IgAN(group A),moderate and severse mesangial proliferative IgAN(group B) and proliferative-sclerosing or sclerosing IgAN(group C) three groups: blood pressure,24 h urinary protein,serum creatinine,Lipoprotein a,blood albumin,Ccr were monitored; The integral of kidney tubules's stroma,the total integral of kidney glomerulus,the integral of sclerosing glomerulus,mesangial proliferation and blood vessels were calculated according to Katafuchi semiquantitative analyses; the expression of TGF-β1 and HGF in renal setions was examined by immuohistochemistry and RT-PCR.Results (1)Among 446 IgAN patients: asymptematic hematuria with or without the presence of proteinuria was the most common clinical manifestation(41.7%--60.5%), follwed by nephroticsyndrome(1.3%--4.9%), chronic nephritis(10.6%--23.5%) ,acute nephritis(1.7%--3.9%) , rapidly progressive glomerulo nephritis(17.1%--28.7%); Pathologically, the proportion of MsPGN were gradually decreased(66.7%--39.1%),but the proportion of FSGS were gradually increased (12.7%--41.7%)year by year. In 2007, the proportion of MsPGN higher than the the proportion of FSGS in the first time.(2)Among 76 IgAN FSGS was the most frequent type in Pathological types . with progression of renal damge, comparison with A group, the levles of blood pressure,24h urinary protein,Lipoproteina,Scr and all the integral of kidney's patholoical index were gradually increased but Ccr,AIb were gradually decreased; As for the above parameters each group excepet blood pressure (between A and B, A and C),the integral of sclerosing glomerulus and the integral blood vessels (between A and B) , all had significant diffrences. Comparison with B group,the levles of Scr and all the integral of kidney's patholoical index were gradually increased but Ccr were gradually decreased,all differences had significant diffrence Compare with A group , levels of TGF-β1 in renal setions were much higher in group B butmuch lower in group C ; the level of HGF in renal setions were gradually decreased with progression of renal damge . Correlation analysis showed that the integral of kidney tubules's stroma was positively correlated with the total integral of kidney glomerulus,the integral of sclerosing glomerulus mesenteria hyperplasia,the integral of sclerosing glomerulus,the integral blood vessels,24h urinary protein and blood pressure (Correlation coefficient were 0.69,0.35,0.70,0.40,0.43,0.26,0.18, P<0.01), and wasn't correlated with the remaining Clinical indicators .The level of HGF was positively correlated with Ccr and AIb ; and wasn't correlated with TGF-β1; and negatively correlated with 24h urinary protein,Scr,Lp(a),the integral of kidney tubules's stroma,the total integral of kidney glomerulus , the integral of sclerosing glomerulus,mesenteria hyperplasia and blood vessels (Correlation coefficient were-0.69,-0.65,-0.70,-0.76,-0.74,-0.69,-0.65,-0.54,P<0.01)。Conclusion (1)The proportion of FSGS increases year by year.(2)asymptematic hematuria with or without the presence of proteinuria can be manifested all of the type in pathological ,say thoughclinical manifestation of thistype is well, the type of pathology isn't very well.(3)Dynamic observation aboue Scr and Ccr will be Significance of prognosis in IgAN.(4)the integral of pathology was positively correlated with the level of pathology , point out it can be consided one of index utending judgement the prognosis of IgAN(5)HGF is gradually reduced with the progression of renal damage,and positively correlated with the clinical index and the integral of pathology,leading to it's meaning of treatment in IgAN. |
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