| Objective:To investigate the expression and clinical significance of serum Vascular Endothelial Growth Factor(VEGF)and Transforming Growth Factor-?1(TGF-?1)in patients with primary gout.The roles and associations between the two proteins in the pathogenesis of renal damage in patients with primary gout are also analyzed.To further investigate the clinical application value of 99mTc-DTPA Renal Dynamic Imaging for evaluating renal damage in patients with primary gout,as well as to provide theoretical basis for early intervention and treatment of renal damage in patients with primary gout.Methods:37 patients with primary Gout(GOUT group)were diagnoses in rheumatology department,and underwent 99mTc-DTPA renal dynamic imaging to measure the values of glomerular filtration rate(GFR)in nuclear medicine department of our hospital,and their serum samples were collected in same time from February 2019 to November 2019.Meanwhile,the serum samples of 32 asymptomatic hyperuricemia patients(HUA group)and 30 healthy control crowds(NC group)were enrolled,all subjects were men.As well as the clinical basic data of all subjects were collected,including BMI,TG,TC,HDL-C,LDL-C,VLDL-C,Scr,BUN,eGFR,SUA,CysC,hsCRP,WBC,etc.The serum levels of VEGF and TGF-?1 were measured by Enzyme-linked immunosorbent assay(ELISA).The imaging parameters of 99mTc-DTPA Renal Dynamic Imaging in patients with primary gout were analyzed.Furthermore,the associations between the expression level of serum VEGF and TGF-?1 with renal impairment and the regulation mechanism ofinteraction between these two proteins in the pathogenesis of renal function injury were investigated in patients with primary gout.Results:1.The serum levels of VEGF and TGF-?1 in Gout group were 159.86±33.2pg/ml and 32.75±5.90ng/ml,respectively.The serum levels of VEGF and TGF-?1 in HUA group were 155.87±24.74pg/ml and 29.84±4.58ng/ml,respectively.The serum levels of VEGF and TGF-?1 in NC group were 102.79±21.13pg/ml and 21.02±4.21 ng/ml,respectively.The serum levels of VEGF and TGF-?1 in Gout group and HUA group were higher than those in NC group(P<0.05),the serum levels of TGF-?1 in Gout group was higher than that in HUA group(P<0.05),and the serum levels of VEGF was higher than that in HUA group(P>0.05),but.the difference was not statistically significant(P>0.05).It suggests that the overexpression of VEGF and TGF-?l may be involved in the occurrence and development of renal function impairment in gout and hyperuricemia.2.The total GFR value,left and right kidney respectively GFR values in the Gout group were 66.96±16.73ml/min,32.50±10.23ml/min and 34.33±8.74 ml/min,respectively.Gout patients were divided into three groups according to the total GFR value:group A(GFR?80ml/min),group B(60ml/min?total GFR<80ml/min)and group C(total GFR<60ml/min).The left kidney TP,right kidney TP,SUA,BUN,and Scr in group C were higher than those in group A and B(P<0.05),while there was no significant difference between groups A and B(P>0.05).There was no significant difference in the expression level of serum VEGF between the three subgroups(P>0.05),while the expression level of serum TGF-?l in group C was higher than that in group A(P<0.05).It suggests that the GFR values measured by 99mTc-DTPA renal dynamic imaging can reflect the early impairment of renal function more sensitively than the conventional blood biochemical indicators in patients with gout,as well as this technology can semi-quantitatively analyze the glomerular filtration function and blood flow perfusion of the left and right kidneys respectively,so as to provide the theoretical basis for clinical early intervention and early treatment of gout.3.The values of total GFR,left and right kidney GFR,and left and right kidney TP in patients with acute gout group were 66.78±13.91ml/min,32.72±10.34ml/min,34.06±6.19ml/min,3.72±1.37min and 3.68±1.16min,respectively.The values of total GFR,left and right kidney GFR,and left and right kidney TP of patients with intermittent gout were 67.05±18.19 ml/min,32.39±10.40ml/min,34.57±9.73ml/min,5.28±3.93min and 4.79±3.02min,respectively.There were no significant difference in all indicators(P>0.05).The serum levels of VEGF and hsCRP in the acute gout group were higher than those in the intermittent gout group(P<0.05),and there was a positive correlation between them(P<0.05).The serum levels of TGF-?1 in the acute gout group was lower than that in the intermittent gout group(P<0.05).It suggests that VEGF and TGF-?1 may be closely related to inflammatory reaction and can be used as an inflammatory index to evaluate the clinical stages of gout patients.4.The values of total GFR,left and right kidney GFR,and left and right kidney TP in the Tophus group were 57.85±14.57ml/min,29.05±8.58ml/min,29.56±9.69ml/min,5.98±3.62min and 5.56±3.61min,respectively.The values of total GFR,left and right kidney GFR,and left and right kidney TP in the non-Tophus group were 65.39±11.47ml/min,34.15±10.71ml/min,36.73±7.20 ml/min,4.19±3.17min and 3.88±1.80min,respectively.There was no significant difference in all indicators(P>0.05).There was no significant difference in VEGF,TGF-?1,BUN and Scr between Tophus group and non-Tophus group(P>0.05).It suggests that VEGF and TGF-?1 may not be necessarily related to the formation of Tophus.The SUA,CysC,hsCRP,age and duration of disease in Tophus group were significantly higher than those in non-Tophus group,and these indicators were statistically significant(P<0.05).5.In gout group,the values of total GFR were negative correlated significantly with the expression levels of VEGF,TGF-?1,SUA,Scr,BUN and CysC(P<0.05).The serum levels of VEGF were positive correlated significantly with SUA,Scr,hsCRP and CysC(P<0.05),while were negative correlated significantly with the values of total GFR and eGFR(P<0.05).The serum levels of TGF-?1 were positive correlated significantly with SUA,Scr and BUN(P<0.05),while were negative correlated significantly with the values of total GFR and eGFR(P<0.05).There was a significant positive correlation between total GFR and eGFR in the gout group(r=0.702,P<0.05).It suggests that VEGF and TGF-?1 may participate in the process of renal interstitial fibrosis in gout patients.6.In HUA group,the serum levels of VEGF were positive correlated significantly with TGF-?1,SUA,Scr,BUN,CysC and hsCRP(P<0.05),while were negative correlated with the values of eGFR(P<0.05).The serum levels of TGF-?1 were positive correlated significantly with SUA,Scr,BUN,CysC and TC(P<0.05),while were negative correlated significantly with the values of eGFR(P<0.05).It suggests that VEGF and TGF-?1 may participate in the process of renal function impairment in hyperuricemia.7.There were no significant correlation between the serum levels of VEGF and TGF-?1 in the Gout group and NC group(r=0.078,0.136,P>0.05).The serum levels of VEGF and TGF-?1 were correlated positively in HUA group(r=0.78,P<0.05).It suggests that the regulation mechanism of the interaction between VEGF and TGF-?1 in gout nephropathy may needs to be further studied.Conclusions:1.The GFR value measured by 99mTc-DTPA renal dynamic imaging can reflect the early impairment of renal function more sensitively in patients with primary gout,as well as can provide theoretical basis for early clinical intervention and early treatment of the early renal function impairment of gout.It is worthy of clinical promotion and application.2.The GFR value of patients with primary gout is negatively correlated with the expression levels of serum VEGF and TGF-?1.It suggests that overexpression of VEGF and TGF-?1 may be involved in the occurrence and development of renal function impairment in primary gout and hyperuricemia.3.The serum levels of VEGF and TGF-?1 may be related to the clinical stage of primary gout patients,while both of them may not be necessarily related to the formation of tophus.4.The mutual regulation mechanism of VEGF and TGF-?1 in the progress of gout nephropathy needs to be further studied. |
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