糖皮质激素受体α及β在皮肌炎/多肌炎患者发病与治疗中的作用

Study of the role of glucocorticoid receptor-alpha and beta mRNA of the peripheral blood mononuclear cells in the pathogenesis and treatment of dermatomyositis/polymyositis

目的探讨糖皮质激素受体(GR)亚型GRα、GRβ在皮肌炎/多肌炎(DM/PM)患者发病及对糖皮质激素治疗反应不同的分子机制。方法采用反转录聚合酶链反应(RT-PCR)方法检测36例DM/PM患者(其中激素敏感组24例、激素抵抗组12例)外周血单个核细胞(PBMCs)内GRα与GRβmRNA表达水平的变化。结果与正常对照组相比,DM/PM患者GRαmRNA的表达水平均降低,差异有统计学意义(P<0.05);GRβmRNA在激素抵抗组中表达明显增高,差异有统计学意义(P<0.01);而在激素敏感组中表达无统计学意义(P>0.05)。结论DM/PM患者GRα、GRβmRNA表达水平的变化,导致GRα与GRβ比例失调,使组织细胞对激素的敏感性降低。因此,导致DM/PM患者对糖皮质激素治疗反应不同,DM/PM患者出现激素抵抗可能与GRβmRNA表达水平增高有关。

Objective To investigate the expression of glucocorticoid receptor-alpha and beta （GRα and GRβ） mRNA of peripheral blood mononuclear cells （PBMCs） in patients with dermatomyositis/polymyositis （DM/PM） and analyze their association with the pathogenesis and clinical response to glucocorticoid therapy. Methods The expression of GRα and GRβ mRNA in PBMCs from 20 normal controls and 36 （24 steroid-sensitive, 12 steroid-resistant） patients with DM/PM were detected by reverse transcription polymerase chain reaction （RT-PCR）. Results Compared to normal controls, the expression of GRα mRNA in the DM/PM was significantly decreased （P〈0.01）. The expression of GRβ mRNA was highly increased in steroid-resistant patients with DM/PM （P〈0.05）, whereas no significant difference was detected in the steroid-sensitive DM/PM patients. Conclusion The changed expression of GRα and GRβ in DM/PM patients not only takes part in the pathogenesis of DM/PM, but also associates with the clinical response of DM/PM.