不同中效糖皮质激素诱导缓解儿童肾病综合征的疗效观察

The different lente glucocorticoid effect of remission induction on children with nephrotic syndrome

目的探讨选用不同中效糖皮质激素(GC)诱导缓解治疗儿童原发性肾病综合征(PNS)的疗效。方法 2008年11月至2010年2月于天津市儿童医院住院治疗的初治PNS患儿54例,随机分为泼尼松组、曲安西龙组、甲泼尼龙组,3组分别给予相应足量激素治疗。动态监测各组24h尿蛋白定量(Upro)、血浆白蛋白(Alb)、血浆胆固醇(Tcho)的变化,同时记录服用GC后尿蛋白转阴的时间。采用半定量逆转录-聚合酶链反应(RT-PCR)方法检测患儿外周血单个核细胞(PBMCs)中糖皮质激素受体(GR)GRα和GRβ的mRNA表达水平。结果甲泼尼龙对24h Upro的降低和血浆Alb的升高作用优于曲安西龙和泼尼松,尿蛋白转阴时间甲泼尼龙组及曲安西龙组较泼尼松组短,甲泼尼龙上调GRα的能力优于曲安西龙及泼尼松,而甲泼尼龙及曲安西龙抑制GRβ表达亢进的能力优于泼尼松。结论服用GC后,尿蛋白的转阴时间、Upro与血Alb的动态变化、GR的水平均可作为PNS诱导缓解期综合评价GC疗效的有价值的客观指标。初治儿童PNSGC诱导缓解的治疗阶段选用甲泼尼龙或曲安西龙的疗效优于泼尼松。

Objective To investigate the effects of different lente glucocorticoid on the primary nephrotic syndrome （PNS） children＇ s remission induction. Methods 54 PNS kid patients at the time of their initial treatment in Tianjin Children＇ s Hospital were randomly divided into three groups：prednisone group, triameinolone group and methylprednisolone group; they were given corresponding GC treatment. Monitor 24-hour urinary protein （Upro） levels, Alb and Tcho. Record the Upro negative conversion time. Test the mRNA expression levels of the glucoeorticoid receptor （GR） subtypes in PBMCs by semi-quantitative RT-PCR. Results Methylprednisolone was better than triamcinolone and prednisone on the 24 h Upro decrease and the increase of plasma Alb. Methylprednisolone and triamcinolone had a shorter Upro negative conversion time than prednisone group. The GR α up-regulation degree of methylprednisolone was better than triamcinolone and prednisone. Methylprednisolone and triamcinolone＇ s down-regulation ability of GR β was superior to prednisone. Conclusion After the GC treatment, the Upro negative conversion time, changes of Upro and Alb and the level of GR can be used as valuable indicators for efficacy assessment at remission induction period. The effects of methylprednisolone or triamcinolone are better than prednisone at the remission induction period of PNS in initial treatment.