Proximal tubular basement membrane width in insulin-dependent diabetes mellitus
Proximal tubular basement membrane width in insulin-dependent diabetes mellitus
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DOI：
10.1046/j.1523-1755.1998.00809.x
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发表时间：
1998-03-01
影响因子：
19.6
通讯作者：
Mauer, M
中科院分区：
文献类型：
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作者：
Brito, PL;Fioretto, P;Mauer, M
虽然肾小球结构已被研究，但尚未对人类糖尿病中的肾小管基底膜（TBM）结构进行仔细评估。我们测量了35例胰岛素依赖型糖尿病（IDDM）患者和20例对照者的近端TBM宽度、肾小球基底膜（GBM）宽度、系膜体积分数[Vv（Mes/glom）]、系膜基质体积分数[Vv（MM/glom）]和皮质间质体积分数[Vv（Int/cortex）]。患者的平均年龄为28 +/- 10岁（X +/- SD），IDDM病程为17 +/- 8年。25例患者为正常白蛋白尿，4例为微量白蛋白尿，6例为明显蛋白尿。采用正交截距法测量肾小管基底膜和GBM宽度，点计数法测量系膜和间质参数。IDDM患者的TBM宽度为915 +/- 320 nm，对照组为558 +/- 116 nm（P = 0.0005）;正常白蛋白尿患者的TBM宽度也增加（849 +/- 297 nm，P = 0.0005）。TBM宽度与GBM宽度（r = 0.67，P < 0.001）、Vv（Mes/glom）（r = 0.52，P < 0.01）和Vv（MM/glom）（r = 0.61，P < 0.001）有很强的直接相关性，但与Vv（Int/cortex）只有很弱的相关性（r = 0.29，NS）。TBM宽度（r = 0.65，P < 0.001）和GBM宽度（r = 0.65，P < 0.001）与HbA（1）C（HbA（1）C）呈强相关，而Vv（Mes/glom）（r = 0.35，P < 0.05）和Vv（Int/cortex）（r = 0.30，NS）与HbA（1）C呈弱相关。因此，近端TBM宽度增加是IDDM患者早期肾脏病理的一个组成部分。这项研究表明，糖尿病的代谢紊乱是人类糖尿病肾病发生的结构异常星座的强有力的决定因素。
Although glomerular structure has been studied, careful evaluation of tubular basement membrane (TBM) structure in diabetes in humans has not been done. We measured proximal TBM width, glomerular basement membrane (GBM) width, mesangial fractional volume [Vv(Mes/glom)], mesangial matrix fractional volume [Vv(MM/glom)], and cortical interstitial fractional volume [Vv(Int/cortex)] in 35 insulin-dependent diabetic (IDDM) patients and 20 controls. The patients' mean age was 28 +/- 10 years (X +/- SD) and IDDM duration was 17 +/- 8 years. Twenty-five patients were normoalbuminuric, four microalbuminuric, and six had overt proteinuria. Tubular basement membrane and GBM widths were measured by the orthogonal intercept method and mesangial and interstitial parameters by point counting. The TBM width was 915 +/- 320 nm in IDDM patients and 558 +/- 116 nm in controls (P = 0.0005); the TBM width was also increased in normoalbuminuric patients (849 +/- 297 nn, P = 0.0005). The TBM width was strongly directly related to GBM width (r = 0.67, P < 0.001), Vv(Mes/glom) (r = 0.52, P < 0.01), and Vv(MM/glom) (r = 0.61, P < 0.001), but only weakly to Vv(Int/cortex) (r = 0.29, NS). The TBM width (r = 0.65, P < 0.001) and GBM width (r = 0.65, P < 0.001) were strongly related to hemoglobin A(1)C (HbA(1)C), while the Vv(Mes/glom) (r = 0.35, P < 0.05) and Vv(Int/cortex) (r = 0.30, NS) were only weakly related to HbA(1)C. Thus, increased proximal TBM width is an integral component of early nephropathology in IDDM patients. This study suggests that the metabolic disturbances of diabetes are strong determinants of the constellation of structural abnormalities occurring in human diabetic nephropathy.