儿童肾病综合征患者外周血单个核细胞中IL-18和NF-κB表达及意义

Expression of interleukin-18 and nuclear factor-kappa B in peripheral blood mononuclear cells of children with primary nephritic syndrome and its clinical significance

目的探讨在活动期和缓解期激素敏感型肾病综合征(SSNS)患儿外周血单个核细胞(PBMC)中白细胞介素18(IL-18)和核因子-κB(NF-κB)检测的临床意义。方法将30例SSNS患儿治疗前和治疗后4周分为活动期组和缓解期组,20例健康儿童作为对照组,收集外周静脉血和24 h尿液,检测生化指标血清白蛋白、总胆固醇、三酰甘油、血尿素氮、血肌酐和24 h尿蛋白定量;提取PBMC,应用酶联免疫吸附试验方法检测上清液中IL-18和NF-κB的表达水平;比较各组IL-18和NF-κB浓度与24 h尿蛋白定量的相关性。结果活动期组与缓解期组生化指标及24 h尿蛋白定量比较差异均有统计学意义(P<0.05);活动期组与缓解期组比较,以及活动期组与对照组比较,IL-18浓度均明显下降(P<0.05),NF-κB浓度均显著下降(P<0.01);缓解期组与对照组比较,IL-18和NF-κB浓度差异均无统计学意义(P>0.05);且IL-18和NF-κB浓度均与24 h尿蛋白定量呈明显正相关(P<0.05)。结论儿童原发性肾病综合征的发病可能与PBMC分泌IL-18和NF-κB活性升高有关,监测IL-18和NF-κB浓度的变化或可作为观察儿童原发性肾病综合征活动的一个重要参考。

Objective To investigate the clinical significance of expression of interleukin- 18（ IL- 18） and nuclear factor- kappa B（ NF- κB） in peripheral blood mononuclear cells of children with steroid- sensitive nephritic syndrome（ SSNS）. Methods Thirty children with SSNS before and after treatment were divided into active stage group and remission group,while twenty healthy children were enrolled as control group. Peripheral venous blood samples were collected to exam the biochemical indexes,including ALB,TC,TG,BUN and Scr; and 24 h urine were collected to exam the 24 h urinary protein. The peripheral blood mononuclear cells（ PBMCs） were extracted to compare the concentration of IL- 18 and NF- κB in PBMCs by ELISA between two groups,and analyze the correlation between IL- 18 / NF- κB and24 h urinary protein. Results There were significant differences in the biochemical indexes and 24 h urinary protein between active stage group and remission group（ P〈0. 05）. Significant reductions both in IL- 18 and NF- κB were observed in active stage group when comparing with those in remitten group or control group（ P〈0. 05）,while there was no significant difference found between remittent group and control group. Linear regression analysis showed that in active stage group,IL- 18 and NF- κB were significantly positively correlated with 24 h urinary protein（ P〈0. 05）. Conclusion The pathogenesis of PNS in children may be related to the PBMC secretion of IL- 18 and increased NF- κB activity,monitoring the changes of IL- 18 and NF- κB concentrations may be used as an important reference for observing the activity of PNS in children.