天津医药

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糖皮质激素受体mRNA在儿童原发性肾病综合征中的表达意义

张碧丽1,李琛2,3,林书祥1,王文红4,李莉5,张瑄1,2,范树颖4,杜悦新1   

  1. 1. 天津市儿童医院
    2.
    3. 河北省沧州市中心医院
    4. 儿童医院肾内科
    5. 天津市儿童医院肾内科
  • 收稿日期:2010-11-18 修回日期:2011-04-07 出版日期:2011-11-15 发布日期:2011-11-15
  • 通讯作者: 张碧丽

Study of mRNA expression of glucocorticoid receptor in children nephrotic syndrome

  • Received:2010-11-18 Revised:2011-04-07 Published:2011-11-15 Online:2011-11-15

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摘要： 摘要 目的：探讨不同类型糖皮质激素（GC）对儿童原发性肾病综合征（PNS）患者糖皮质激素受体（GR）的影响。方法：正常儿童为对照组(N组) 20例；55例初治PNS患儿随机分为泼尼松组（A组）17例，曲安西龙组（B组）20例,甲基泼尼松龙组（C组）18例,均给予相应GC治疗并在0、4及8周时取静脉血，通过半定量逆转录-聚合酶链反应（RT-PCR）法检测外周血单个核细胞（PBMCs）中GRα和GRβ的mRNA表达水平，并记录GC治疗反应。结果：GC治疗0周时 PNS组GRα低于N组，GRβ高于N组，差异有统计学意义(P < 0.05)。各组患儿经GC治疗后，GRα、GRβ指标组间、时间效应差异均有统计学意义（P < 0.05或P < 0.01）； GRα指标时间与组间无交互作用（P > 0.05）,GRβ指标时间与组间存在交互作用（P < 0.05）。55例PNS患儿中GC耐药组6例，敏感组49例，2组患儿经GC治疗后，GRα、GRβ指标组间差异、时间效应差异均有统计学意义（P < 0.05或P < 0.01）；各组GRα指标时间与组间效应无交互作用（P > 0.05）,但GRβ指标时间与组间存在交互作用（P < 0.05）。结论：PNS患儿PBMCs中GRα和GRβ的mRNA表达存在异常，GC治疗8周时GR表达水平的高低,可判断GC疗效及PNS患者对GC的敏感性。在调节GR的表达水平上甲泼尼龙治疗PNS效果较好。

关键词: 肾病综合征, 原发性, 糖皮质激素受体, 曲安西龙, 甲基泼尼松龙, 泼尼松

Abstract: Abstract Objective：To observe the mRNA expression levels of GRα and GRβ as well as changes of various clinical indicators during the treatment of children PNS to evaluate the efficacy of glucocorticoids (GC). Methods：20 healthy children were selected randomly as control group(N group), 55 PNS kid patients are randomly divided into prednisone group(A group,n =17), triamcinolone group（B group，n = 20）, methylprednisolone group（C group，n=18）. After corresponding GC application, collect blood at 0th, 4th and 8th weeks; test the mRNA expression levels of the GR subtypes in PBMCs by semi-quantitative RT-PCR; record the response to hormone therapy and make follow-up prognosis. Results：At 0th week, the GRα of PNS group is lower than N group (P <0.05); the level of GRβis higher than N group (P <0.05). As the treatment time increases, statistically significant difference of GRαand GRβ were found amony three groups and time effects（(P <0.05 or P<0.01）.Differences in interaction between groups and time effect were only significant in level of GRβ(P <0.05).There were 6 cases of PNS children steroid-resistance; As the treatment continues, there were statistically significant difference of GRα and GRβbetween two groups and time effects（P < 0.05 or P < 0.01）.Differences in interaction between groups and time effect were only significant in level of GRβ(P <0.05). Conclusion : Abnormities are found in the mRNA expression of GRα and GRβ of PNS children. The expression level of GRα and GRβ may evaluate GC effects and the steroid sensitive of PNS children at 8th weeks. The effect of methylprednisolone is best in the way of GR regulation.

Key words: nephrotic syndrome, primary, glucocorticoid receptor, triamcinolone, prednisone, methylprednisolone