外周血及组织糖皮质激素受体表达水平与肾病综合征患者泼尼松治疗效果的相关性

Correlation between the expression levels of glucocorticoid receptors in peripheral blood and tissues and the therapeutic effect of prednisone in patients with nephrotic syndrome

目的探讨外周血及组织糖皮质激素受体(GR)表达水平与肾病综合征(NS)患者泼尼松治疗效果的相关性。方法选取2018年1月—2020年9月重庆市沙坪坝区中西医结合医院收治NS患者138例,均予以泼尼松治疗,根据治疗效果分为有效组和无效组。收集2组患者一般资料、实验室检查资料,采用多因素logistic回归模型建立影响NS患者泼尼松治疗效果的相关因素。使用限制性立方样条图拟合外周血及组织GR表达水平与NS患者泼尼松治疗效果间的相关性。结果截至随访结束,最终纳入133例患者(5例失访),其中43例无效(32.33%),90例有效(67.67%);无效组尿γ-谷氨酰转肽酶(γ-GT)、肾小球GR、外周血GR表达水平低于有效组,24 h尿蛋白水平高于有效组(P<0.05)。多因素logistic显示:尿蛋白(OR=5.394,95%CI 2.120~13.720)为NS患者泼尼松治疗效果的危险因素;尿γ-GT(OR=0.950,95%CI 0.907~0.995)、肾小球GR(OR=0.570,95%CI 0.392~0.827)、外周血GR(OR=0.995,95%CI 0.992~0.997)为NS患者泼尼松治疗效果的保护因素(均P<0.05)。限制性立方条图显示,外周血及组织GR水平与NS患者泼尼松治疗效果呈显著非线性关系(χ^(2)=31.760,P<0.001;χ^(2)=20.770,P<0.001)。结论外周血及组织GR表达水平与NS患者泼尼松治疗效果存在相关性。

Objective To investigate the correlation between glucocorticoid receptor(GR)expression levels in peripheral blood and tissue and the therapeutic efficacy of prednisone in patients with nephrotic syndrome(NS).Methods A total of 138 NS patients were selected from the patients that admitted to the Shapingba District Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to September 2020.All patients received prednisone treatment and were divided into effective and ineffective groups based on treatment outcomes.General information and laboratory examination data were collected for both groups.A multifactor logistic regression model was used to establish the relevant factors affecting the therapeutic efficacy of prednisone in NS patients.A restricted cubic spline plot was employed to depict the correlation between GR expression levels in peripheral blood and tissue and the therapeutic efficacy of prednisone in NS patients.Results At the end of follow-up,a total of 133 cases were included(5 cases were lost to follow-up),among which 43 cases were ineffective(32.33%)and 90 cases were effective(67.67%).The ineffective group exhibited lower levels of urinary γ-GT,glomerular GR,and peripheral blood GR expression compared to the effective group,while 24-hour urine protein levels were higher in the ineffective group(P<0.05).Multifactor logistic regression revealed that urinary protein(OR=5.394,95%CI 2.120~13.720)was a risk factor for the therapeutic efficacy of prednisone in NS patients,while urinaryγ-GT(OR=0.950,95%CI 0.907~0.995),glomerular GR(OR=0.570,95%CI 0.392~0.827)and peripheral blood GR(OR=0.995,95%CI 0.992~0.997)were protective factors(all P<0.05).The restricted cubic spline plot indicated a significant nonlinear relationship between peripheral blood and tissue GR levels and the therapeutic efficacy of prednisone in NS patients(χ^(2)=31.760,P<0.001;χ^(2)=20.770,P<0.001).Conclusions There is a correlation between the expression levels of peripheral blood and tissue GR and the therapeutic efficacy of prednisone in NS patients.