原发性肾病综合征患儿血尿IFN-γ、IL-13、TGF-β_1的变化及黄芪的作用

Changes of Serum and Urinary IFN-γ,IL-13 and TGF-β_1 in Children with Primary Nephrotic Syndrome and Effect of Astragalus

目的探讨原性肾病综合征(PNS)患儿血、尿IFN-γ、IL-13、TGF-β1水平的变化及黄芪的干预作用。方法 46例PNS患儿随机分为黄芪治疗组(Ⅰ组,n=24),PNS对照组(Ⅱ组,n=22),观察用药前后血清及尿液IFN-γ、IL-13、TGF-β1水平及临床转归。健康儿童20例为正常对照组(Ⅲ组)。结果血清IFN-γ、IL-13水平,入院时Ⅰ、Ⅱ组均显著高于Ⅲ组(P均<0.01);缓解后其水平均虽显著下降(P均<0.01),但I组的下降明显高于Ⅱ组(P均<0.01),与Ⅲ组比较已无显著差异(P均>0.05),而Ⅱ组仍显著高于Ⅲ组(P均>0.05)。血清TGF-β1水平入院时Ⅰ、Ⅱ组均显著高于Ⅲ组(P均<0.01);缓解后均显著下降,与Ⅲ组比均已无显著差别(P均>0.05),Ⅰ组与Ⅱ组比较亦无显著差别(P>0.05)。尿液IFN-γ、IL-13、TGF-β1水平与血清IFN-γ、IL-13、TGF-β1水平一样用药前后也发生相同的变化。继发感染率和反复或复发率Ⅰ组均显著低于Ⅱ组(分别为50%比81.8%和33.3%比63.6%,分别2χ=5.123,4.224,P均<0.05)。感染后治愈天数Ⅰ组显著少于Ⅱ组(5.0±1.6天比8.0±2天,t=3.066,P<0.005)。结论 IFN-γ、IL-13、TGF-β1各细胞因子可能均参与PNS的发病;黄芪对血、尿IFN-γ、IL-13有一定的调节作用。黄芪在佐治SNS中具有预防和降低感染、减少和预防反复或复发、避免反复大量应用激素的作用。

Objective To investigate the changes of interferon –gamma（IFN-γ）,interleukin-13（IL-13） and transforming growth factor beta 1（TGF-β1） in serum and urinary in children with primary nephrotic syndrome（PNS） and study the effect of astragalus.Methods Forty-six children with PNS were randomly divided into two groups：astragalus granula treatment group（Ⅰ group,n=24） and prednison control group（Ⅱ group,n=22）.In addition,20 healthy children were normal control group（Ⅲ group）.The treatment protocol of prednison used for 6 months was administered in two groups,while 15g（1bag） astragalus granula orally twice a day was added to children in I group for 3 to 6 months.The levels of IFN-γ,IL-13 and TGF-β1 in the serum and urin of 46 children with PNS were assayed on admission and after alleviation respectively by ELISA.The rates of remission within 8 weeks,complicated infection,and relapse within 3 months and the recovery time of infection were observed in Ⅰ group and Ⅱ group.Results The levels of serum IFN-γ and IL-13 in Ⅰ group and Ⅱ group were significantly higher than those in Ⅲ group（P0.01 for all） on admission,and dropped markedly.There was no significant difference between group Ⅰ and group Ⅲ（P0.01 for all）.But they were still significantly higher in Ⅱ group than in Ⅲ group（P0.01 for all）and obviously lower in Ⅰ group than in Ⅱ group（P0.01 for all）after alleviation.The serum TGF-β1 in Ⅰ group and Ⅱ group were markedly increased and dropped（P0.01 all） on admission and after alleviation respectively,and were not significant different（P0.05 for all） as compared to Ⅲ group after alleviation.The levels of urinary IFN-γ,IL-13 and TGF-β1 were same changes with their serum values in 3 groups.The rates of complicated infection and relapse within 3 months were all significantly lower in Ⅰ group than those in Ⅱ group（50% vs 81.9% and 33.3% vs 83.6%,χ2=5.123,4.224,respectively,P0.05）.The recovery time of complicated infection was obviously shortened in Ⅰ group comparing to Ⅱ group（5.0±1.6d vs 8.0±2.0d,t=3.066,P0.05）.Conclusion IFN-γ,IL-13,TGF-β1 may be involved in the pathogenesis of PNS.Astragalus could decrease the levels of serum and urinary IFN-γ and IL-13 and may be helpful for protecting from and decreasing infection,diminishing relapse and reduling steroid dosage using in children with PNS.