疑难病杂志
疑難病雜誌
의난병잡지
JOURNAL OF DIFFICULT AND COMPLICATED CASES
2015年
9期
947-949,955
,共4页
李益%王俭%万光平%古智兵%汪祝强
李益%王儉%萬光平%古智兵%汪祝彊
리익%왕검%만광평%고지병%왕축강
儿童原发性肾病综合征%糖皮质激素耐药性%糖皮质激素受体
兒童原髮性腎病綜閤徵%糖皮質激素耐藥性%糖皮質激素受體
인동원발성신병종합정%당피질격소내약성%당피질격소수체
Children primary nephrotic syndrome%Glucocorticoid resistance%Glucocorticoid receptor
目的：探讨原发性肾病综合征（PNS）患儿糖皮质激素（GC）耐药性与糖皮质激素受体mRNA（包括GRα与GRβ）表达的相关性。方法选择2012年6月—2014年12月儿科住院的初诊并予大剂量激素治疗PNS患儿80例作为研究组，按照患儿GC疗效反应分为激素敏感亚组与耐药亚组；另选择正常同龄儿童30例作为健康对照组。于治疗前采取静脉血5 ml，使用荧光定量PCR方法检测并比较外周血单个核细胞（PBMCs）中GRα和GRβ的mRNA表达水平。结果80例PNS患儿中出现GC耐药15例（18．8％），GC敏感65例（81．2％），与健康对照组相比，研究组PBMCs的GRαmRNA、GRβmRNA表达水平均较高，差异均有统计学意义（ P ＜0．05）。与GC耐药亚组相比，GC敏感亚组PBMCs的GRβmRNA表达水平较高，差异有统计学意义（ P ＜0．05），而GRαmRNA表达水平差异无统计学意义（ P ＞0．05）。采用Logistic回归分析校正相关混杂因素后显示，患儿PBMCs的GRβmRNA表达水平是GC耐药性的独立危险因素（OR＝2．17，95％CI 1．17～9．21， P ＜0．05）。结论儿童PNS PBMCs的GRβmRNA表达水平是GC耐药性的独立危险因素，可作为预测GC反应性的临床参考指标。
目的：探討原髮性腎病綜閤徵（PNS）患兒糖皮質激素（GC）耐藥性與糖皮質激素受體mRNA（包括GRα與GRβ）錶達的相關性。方法選擇2012年6月—2014年12月兒科住院的初診併予大劑量激素治療PNS患兒80例作為研究組，按照患兒GC療效反應分為激素敏感亞組與耐藥亞組；另選擇正常同齡兒童30例作為健康對照組。于治療前採取靜脈血5 ml，使用熒光定量PCR方法檢測併比較外週血單箇覈細胞（PBMCs）中GRα和GRβ的mRNA錶達水平。結果80例PNS患兒中齣現GC耐藥15例（18．8％），GC敏感65例（81．2％），與健康對照組相比，研究組PBMCs的GRαmRNA、GRβmRNA錶達水平均較高，差異均有統計學意義（ P ＜0．05）。與GC耐藥亞組相比，GC敏感亞組PBMCs的GRβmRNA錶達水平較高，差異有統計學意義（ P ＜0．05），而GRαmRNA錶達水平差異無統計學意義（ P ＞0．05）。採用Logistic迴歸分析校正相關混雜因素後顯示，患兒PBMCs的GRβmRNA錶達水平是GC耐藥性的獨立危險因素（OR＝2．17，95％CI 1．17～9．21， P ＜0．05）。結論兒童PNS PBMCs的GRβmRNA錶達水平是GC耐藥性的獨立危險因素，可作為預測GC反應性的臨床參攷指標。
목적：탐토원발성신병종합정（PNS）환인당피질격소（GC）내약성여당피질격소수체mRNA（포괄GRα여GRβ）표체적상관성。방법선택2012년6월—2014년12월인과주원적초진병여대제량격소치료PNS환인80례작위연구조，안조환인GC료효반응분위격소민감아조여내약아조；령선택정상동령인동30례작위건강대조조。우치료전채취정맥혈5 ml，사용형광정량PCR방법검측병비교외주혈단개핵세포（PBMCs）중GRα화GRβ적mRNA표체수평。결과80례PNS환인중출현GC내약15례（18．8％），GC민감65례（81．2％），여건강대조조상비，연구조PBMCs적GRαmRNA、GRβmRNA표체수평균교고，차이균유통계학의의（ P ＜0．05）。여GC내약아조상비，GC민감아조PBMCs적GRβmRNA표체수평교고，차이유통계학의의（ P ＜0．05），이GRαmRNA표체수평차이무통계학의의（ P ＞0．05）。채용Logistic회귀분석교정상관혼잡인소후현시，환인PBMCs적GRβmRNA표체수평시GC내약성적독립위험인소（OR＝2．17，95％CI 1．17～9．21， P ＜0．05）。결론인동PNS PBMCs적GRβmRNA표체수평시GC내약성적독립위험인소，가작위예측GC반응성적림상삼고지표。
Objective To investigate the relationship between glucocorticoid ( GC) and the expression of glucocorti-coid receptor mRNA (GR) in patients with primary nephrotic syndrome (PNS).Methods From June 2012 to December 2014 , 80 cases of newly diagnosed pediatric PNS children who treated with high dose of corticosteroid were enrolled as study group.According to the curative effect of GC , these children were divided into hormone sensitive subgroup and resistance sub-group, and 30 cases normal children of the same age were enrolled as healthy controls .Venous blood was taken at 5 ml before treatment, and the mRNA expression level of GR αand GRβin peripheral blood mononuclear cells (PBMCs) were detected by fluorescence quantitative PCR.Results 80 cases of PNS children had 15 cases of GC resistance(18.8%),65casesof GC sensitive (81.2%), compared with the healthy control group, the study group’s PBMCs in GR αmRNA and GR beta mRNA expression levels were higher , the differences were statistically significant ( P <0.05).Compared with the subgroup of GC resistance, GC sensitive subgroup ’ s PBMCs of glucocorticoid receptor beta mRNA expression was higher , and the difference was statistically significant ( P <0.05), and GR mRNA expression level’s differences had no statistical signifi-cance ( P >0.05).Using logistic regression analysis adjusted for confounding factors , study group children’s PBMCs of glu-cocorticoid receptor beta mRNA expression levels is independent risk factors of GC resistance (OR=2.17, 95% CI 1.17~9.21, P <0.05).Conclusion PNS children’ s glucocorticoid receptor beta mRNA expression level in PBMCs is an inde-pendent risk factor for GC resistance , may use as a clinical reference index for predicting GC response .
