P-糖蛋白170在原发性肾病综合征患儿糖皮质激素耐药中的作用

Role of P-gp170 in steroid-resistant primary nephrotic syndrome in children

目的探讨原发性肾病综合征(PNS)患儿治疗前外周血单个核细胞(PBMC)P-糖蛋白170(P-gp170)与糖皮质激素(GC)耐药的关系。方法采用流式细胞仪(FCM)检测30例PNS患儿PBMCP-gp170的表达,并分析其与复发次数、24h尿蛋白定量(24hUTP)及肾脏病理积分的关系。根据随访结果分成激素耐药型肾病综合征(SRNS)和激素敏感型肾病综合征(SSNS)2组,各15例。10例健康体检儿童作为正常对照组。结果SRNS组患儿PBMCP-gp170的表达量显著高于SSNS组患儿(P均<0.05)。PNS患儿激素治疗前PBMCP-gp170的表达量与复发的次数呈正相关(r=0.399,P<0.05);SRNS患儿激素治疗前PBMCP-gp170的表达量与24h尿蛋白定量(24hUTP)及肾脏病理积分均呈正相关(r=0.576、0.529,P均<0.05)。结论PBMCP-gp170表达增高可能与PNS患儿GC耐药有关,可作为PNS患儿GC耐药的标志之一。PBMCP-gp170表达增高与PNS活动、复发及病理有关,可做为临床判断预后的指标。

Objective To study the relationship between the expression of P-gp170 on peripheral blood mononuclear cell （PBMC） and glucocorticoid resistance in pediatric patients with primary nephritic syndrome （PNS） before steroid therapy.Methods Flow cytometry （FCM） technique was applied to quantitatively analyze the expression of P-gp170 on PBMC in 30 PNS patients.Thirty children with PNS were recruited before any glucocorticoid treatment,and divided into two groups （SSNS group and SRNS group）.Ten healthy children were served as control.Relationship between the expression of P-gp170,the frequency of recurrence,24 h urine total protein （24 h UTP）,and kidney pathology score was analyzed.Results In SRNS patients,the expression of P-gp170 were significantly higher than that in SSNS patients （P〈 0.05）.The expression of P-gp170 before glucocorticiod treatment was positively correlated with the frequency of recurrence （r=0.399,P〈 0.05）.In SRNS patients,the expression of P-gp170 before glucocorticiod treatment was positively correlated with 24 h urine total protein （24 h UTP） and kidney pathology score （r=0.576,0.529,P〈 0.05）.Conclusions The higher expression of P-gp170 may contribute to the glucocorticoid resistance in PNS patients,and it may be served as one of possible marks of glucocorticoid resistance.The expression of P-gp170 was positively correlated with the kidney pathology score and the frequency of recurrence,and it may be useful in assessing the prognosis of PNS patients.