STRUCTURAL-FUNCTIONAL RELATIONSHIPS IN DIABETIC NEPHROPATHY
STRUCTURAL-FUNCTIONAL RELATIONSHIPS IN DIABETIC NEPHROPATHY
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DOI：
10.1172/jci111523
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发表时间：
1984-01-01
影响因子：
15.9
通讯作者：
GOETZ, FC
中科院分区：
文献类型：
--
作者：
MAUER, SM;STEFFES, MW;GOETZ, FC
本文应用半定量光镜和电镜体视学形态计量学方法对45例胰岛素依赖型糖尿病（IDDM）患者的肾活检组织进行了观察。在这14名男性和31名女性中，年龄13-52岁，患有IDDM 2.5-29年，肾小球基底膜（GBM）厚度或系膜扩张与IDDM的持续时间之间没有很强的关系。GBM的厚度和系膜的扩张之间只有微弱的关系。因此，GBM增厚和系膜扩张在IDDM中的发生率通常彼此不同，并且在患者之间差异很大。糖尿病肾病、蛋白尿、高血压、肾小球滤过率下降等临床表现与肾小球基底膜增厚关系不大或根本不相关。相比之下，所有光镜和EM测量的系膜扩张与糖尿病肾病的临床表现密切相关，尽管在没有这些临床结果的情况下，不可能预测任何糖尿病肾小球病变的严重程度。肾小球系膜扩张与毛细血管滤过表面积密度呈强负相关。系膜扩张可通过限制肾小球毛细血管及其滤过表面而导致肾小球功能恶化。然而，毛细血管闭合、肾小球硬化和间质纤维化也可能导致这种疾病的临床表现。
Renal biopsies in 45 patients with insulin-dependent diabetes mellitus (IDDM) were examined by semiquantitative light microscopy and quantitative EM stereologic morphometry. In these 14 males and 31 females, aged 13-52 yr, who had had IDDM for 2.5-29 yr there was no strong relationship between either glomerular basement membrane (GBM) thickness or mesangial expansion and duration of IDDM. There was only a weak relationship between the thickness of the GBM and expansion of the mesangium. Thus, GBM thickening and mesangial expansion in IDDM occur at rates that often differ from one another and that vary greatly among patients. The clinical manifestations of diabetic nephropathy, albuminuria, hypertension and decreased glomerular filtration rate related poorly or not at all to GBM thickening. In contrast, all light microscopic and EM measures of mesangial expansion were strongly related to the clinical manifestations of diabetic nephropathy, although in the absence of these clinical findings, it was not possible to predict the severity of any of the diabetic glomerular lesions. Mesangial expansion had strong inverse correlations with capillary filtering surface area density. Mesangial expansion could lead to glomerular function deterioration in IDDM by restricting the glomerular capillary vasculature and its filtering surface. However, capillary closure, glomerular sclerosis, and interstitial fibrosis could also contribute to the clinical manifestations of this disorder.