CAJ | 학술논문

目的：探讨外周血TGF-β1及IL-18 mRNA表达水平在儿童原发性肾病综合征（PNS）的临床诊断分型及病情评估中的作用。方法采用实时聚合酶链反应(RT-PCR)技术，对77例PNS患儿及30例健康对照儿童外周血单个核细胞(PBMC)中TGF-β1和IL-18 mRNA表达水平进行检测。结果激素敏感型肾病综合征（SSNS）患儿中，在激素治疗0（治疗前）、1、4周时，单纯型肾病患儿血PBMC中TGF-β1及IL-18 mRNA的水平低于肾炎型肾病患儿，差异有统计学意义（P均<0.05）。在激素治疗0周时，SSNS患儿TGF-β1 mRNA的水平低于激素耐药型肾病综合征（SRNS）患儿，差异有统计学意义（P<0.05）。随着激素治疗时间的延长，各组患儿TGF-β1 mRNA的水平均呈逐渐下降趋势。SRNS患儿中，在激素治疗0、1周时，单纯型肾病患儿血PBMC中IL-18 mRNA的表达水平低于肾炎型肾病患儿，差异有统计学意义（P<0.05）。SSNS患儿中，活动期组TGF-β1及IL-18 mRNA水平均高于缓解组，差异有统计学意义(P<0.01)。结论 PNS疾病初期，检测患儿血清PBMC中TGF-β1、IL-18 mRNA表达水平，对评估患儿疾病的活动情况、临床鉴别单纯型肾病与肾炎型肾病及临床早期预测激素耐药有一定意义。
목적：탐토외주혈TGF-β1급IL-18 mRNA표체수평재인동원발성신병종합정（PNS）적림상진단분형급병정평고중적작용。방법채용실시취합매련반응(RT-PCR)기술，대77례PNS환인급30례건강대조인동외주혈단개핵세포(PBMC)중TGF-β1화IL-18 mRNA표체수평진행검측。결과격소민감형신병종합정（SSNS）환인중，재격소치료0（치료전）、1、4주시，단순형신병환인혈PBMC중TGF-β1급IL-18 mRNA적수평저우신염형신병환인，차이유통계학의의（P균<0.05）。재격소치료0주시，SSNS환인TGF-β1 mRNA적수평저우격소내약형신병종합정（SRNS）환인，차이유통계학의의（P<0.05）。수착격소치료시간적연장，각조환인TGF-β1 mRNA적수평균정축점하강추세。SRNS환인중，재격소치료0、1주시，단순형신병환인혈PBMC중IL-18 mRNA적표체수평저우신염형신병환인，차이유통계학의의（P<0.05）。SSNS환인중，활동기조TGF-β1급IL-18 mRNA수평균고우완해조，차이유통계학의의(P<0.01)。결론 PNS질병초기，검측환인혈청PBMC중TGF-β1、IL-18 mRNA표체수평，대평고환인질병적활동정황、림상감별단순형신병여신염형신병급림상조기예측격소내약유일정의의。
Objective To study the clinical significance of transforming growth factor (TGF)-β1 and interleukin (IL)-18 mRNA in the diagnosis and evaluation of disease severity of primary nephrotic syndrome (PNS) in children. Methods The ex-pression levels of TGF-β1 and IL-18 mRNA in peripheral blood mononuclear cells (PBMC) were measured by real-time lfuorescent quantitative polymerase reaction (RT-PCR) in 77 children with PNS and 30 healthy children (control group). Results In children with steroid-sensitive nephrotic syndrome (SSNS), the expression levels of TGF-β1 and IL-18 mRNA before treatment and at 1, 4 weeks after hormone therapy were signiifcantly lower in children with simple type nephrotic syndrome than those in children with nephritic type nephrotic syndrome (P<0.05). The level of TGF-β1 mRNA before treatment was signiifcantly lower in children with SSNS than that in children with steroid-resistant nephrotic syndrome (SRNS). With the extension of hormone therapy, the expression levels of TGF-β1 mRNA showed a trend of declining in children with PNA. In children with SRNS, the expression levels of TGF-β1 and IL-18 mRNA before treatment and at 1, 4 weeks after hormone therapy were signiifcantly lower in children with simple type NS than those in children with nephritic type nephrotic syndrome (P<0.05). In children with SSNS, the levels of TGF-β1 and IL-18 mRNA were signiifcantly higher in acute phase than those in the remission phase. Conclusions At the early stage of PNS, the detection of the expression levels of TGF-β1 and IL-18 mRNA is useful for evaluatation of disease activity, clinical identiifcation of nephritic type nephrotic syndrome and simple type nephrotic syndrome and early prediction of SRNS.