糖皮质激素对狼疮性肾炎患者高迁移率族蛋白B1的表达影响

Effect of glucocorticoid on the expression of high mobility group box protein 1 in lupus nephritis patients

目的研究糖皮质激素(GC)对狼疮性肾炎(LN)患者体内高迁移率族蛋白B1(HMGB1)水平及临床指标的变化及其关系。方法选取20例狼疮性肾炎患者(试验组),10例健康对照者(对照组)和10例肿瘤切除正常肾组织(对照肾组织组),试验组口服醋酸泼尼松片1.0 mg·kg-1·d-1,疗程2周,检测2组治疗前后血清、尿液HMGB1的表达水平及临床指标的变化,检测其肾组织HMGB1的表达变化。结果试验组血清、尿液的HMGB1的表达水平显著高于对照组(P<0.05);且狼疮性肾炎Ⅳ型的血HMGB1表达水平明显高于狼疮性肾炎Ⅲ型(P<0.05)。对照组肾小管上皮细胞中等强度表达HMGB1,试验组肾小管HMGB1的表达显著增强,肾小球也明显表达,且肾内的HMGB1表达水平较对照组明显增加(P<0.05)。试验组治疗后系统性红斑狼疮疾病活动指数(SLEDAI)、24 h尿蛋白定量、血白蛋白、补体C3、C4指标较治疗前明显改善(P<0.05);血清HMGB1的水平较治疗前明显降低(P<0.05)。结论糖皮质激素治疗狼疮性肾炎的作用可能与降低患者体内HMGB1水平有关。

Objective To explore the change of high mobility group box protein B1（ HMGB1） and clinical index in patients with lupus nephritis（ LN） before and after treatment of glucocorticoid（ GC） and to clarify its action mechanism on LN. Methods A total of 20 patients with lupus nephritis（ trail group）,10 healthy controls（ control group） and 10 tumor resection patients（ normal kidney tissue group） were selected. Trial group were given prednisone acetate 1. 0 mg · kg- 1· d- 1for two weeks. The serum and urine levels of HMGB1 were detected before and after treatment in two groups,intrarenal expressions of HMGB1 were detected in renal tissues of LN and normal- appearing renal tissues.Results The serum,urine levels of HMGB1 in trial group were significantly higher than those in control group（ P〈0. 05）; the serum concentrations of HMGB1 in LN Ⅳ were higher than that in LN Ⅲ（ P〈0. 05）;intermediate- intensity staining of HMGB1 were detected in renal tubules in control group,however,both renal tubules and glomerular cells had the strong expression of HMGB1 in trial group; the intrarenal production of HMGB1 in trial group were obviously higher than that in control group（ P〈0. 05）; compared with those before treatment, systemic lupuserythematousus activity index（ SLEDAI）,24- hour urine protein,serum albumin,C3,C4 in trial group after treatment showed a marked improvement,the difference was statistically significant（ P〈0. 05）; the serum levels of HMGB1 in trial group after treatment were obviously lower than those before treatment（ P〈0. 05）. Conclusion The effect of GC therapy with LN may be associated with the decrease of HMGB1 levels.