儿童原发性肾病综合征外周血GRβ及TNF-α的变化及意义

Changes of GRβ and TNF-α in Peripheral Blood of Patients with Primary Nephritic Syndrome

目的 探讨原发性肾病综合征（PNS）患儿外周血单个核细胞（PBMC）上糖皮质激素受体β（GRβ）及肿瘤坏死因子α（TNF-α）与糖皮质激素治疗效应之间的关系.方法 以30例PNS患儿作为观察组,根据随访结果分成激素耐药型（SRNS）和激素敏感型（SSNS）2 组,各15例.10名健康儿童作为正常对照组.应用RT-PCR 检测各组PBMC上GRβmRNA的表达;采用ELISA方法检测各组血浆中TNF-α的含量;并分析以上指标与肾脏病理及相关实验室指标的关系.结果 （1）SSNS组患儿PBMC GRβmRNA的表达及血浆TNF-α水平均高于对照组（P＜0.05）.（2）SRNS组患儿PBMC GRβmRNA的表达及血浆TNF-α水平均高于SSNS组（P＜0.01）.（3）15例SRNS组患儿PBMC GRβmRNA的表达与肾脏病理分级成等级正相关（r=0.496,P＜0.05）;与24小时尿蛋白定量（24hUTP）成等级正相关（r=0.458,P＜0.05）.（4）15例SSNS组患儿PBMC GRβmRNA的表达与24hUTP无相关性（P＞0.05）.（5）30例PNS患儿PBMC GRβmRNA的表达与血浆TNF-α水平成等级正相关（r=0.450,P＜0.05）.结论 GRβ可以作为监测PNS患儿病情以及预后的指标之一.TNF-α升高可能导致GRβmRNA的表达升高,在SRNS形成与发展中起到重要作用.

Objective To investigate, the expression of GR β and TNF-α in the patients with primary nephritic syndrome（PNS） and explore the relationship between （3R 13 expression and therapeutic effect of steroids,the possible role of TNF-α in the steroid resistance of PNS is also explored in this study. Methods 30 PNS patients were researched in this study（15 SSNS patients as group 1,the other 15 SRNS patients as group 2）,10 healthy children were as control group.Applying reverse transcription polymerase chain reaction（RT-PCR） and ELISA to detect the expression of GR β mRNA and serum TNF-α respectively.The relationship between these GR β mRNA and renal pathology,24h UTP were analyzed.Result （1）The expression of GR β mRNA and TNF-α in the SSNS patients were both higher than the control（P 〈 0.05）.（2）The expression of GR β mRNA and TNF- α in the SRNS patients were both higher than the SSNS patients（P 〈 0.0l）.（3）There were positive correlation between GR β mRNA expression and renal pathology（r=0.496,P 〈 0.05）,24h UTP（r=0.458,P 〈 0.05） respectively in β SRNS patients.（4）The expression of GR β mRNA have not the significant correlation with 24h UTP in the SSNS group（P 〉 0.05）.（5）There were positive correlation between GR 13 mRNA expression and TNF-α in all 30 PNS patients（r-=0.45,P 〈 0.05）. Conclution GR β may take part in the development and progression of SRNS,and could be used as one immunology index to monitor the condition of PNS and assess the prognosis.TNF-α may have important role in the development and progression of SRNS by increasing the GR β mRNA expression.