【摘要】 目的:探讨特发性膜性肾病(IMN)患者外周血中单个核细胞(PBMC)中GRα和GRβ与临床缓解的相关性。方法:选取大连医科大学附属一院肾内科2013年10月至2015年3月经肾活检确诊为IMN的患者26例,所有IMN患者在糖皮质激素治疗8周后联合他克莫司;同时选取健康志愿者10例为对照组。分别留取患者在发病时(基线)、糖皮质激素治疗8周和达到缓解时清晨空腹血标本,提取外周血中单个核细胞,同时每月检测尿蛋白定量、血清白蛋白和肾功能。进行12个月的跟踪随访。采用Real Time PCR检测PBMC中GRα和GRβmRNA的差异,采用Western blot检测GRα和GRβ的蛋白表达差异,COX回归分析IMN患者PBMC中GRα/β与临床缓解的相关性。结果:26例IMN完全缓解(CR) 9例,部分缓解(PR) 6例,未缓解(NR) 11例。RT-PCR结果显示:与对照组相比,IMN组PBMC中GRα的表达降低(P<0. 05),而GRβ的表达明显升高(P<0. 05); GRα/GRβ明显降低(P<0. 05)。Western blot检测结果显示:与对照组相比,IMN组GRα的蛋白表达无变化(P>0. 05),而GRβ的蛋白表达明显增高(P<0. 05)。COX回归分析结果显示:年龄、病程、血压、24 h尿蛋白定量、白蛋白、肌酐、胆固醇、三酰甘油、纤维蛋白原与临床缓解无明显相关性(P>0. 05),基线时GRα/β基因表达与临床缓解有关(P<0. 05)。结论:IMN患者PBMC中基线GRαmRNA与GRα/βmRNA与临床缓解呈正相关。更多还原

【Abstract】 Objective: To explore the relationship between expression of GRα/β in peripheral blood mononuclear cells of patients with idiopathic membranous nephropathy(IMN) and clinical. Methods: Choose 26 patients with IMN by renal biopsy diagnosis as IMN group between October 2013 and March 2015 in the First Hospital of Dalian Medical University,10 cases of health blood donors as control group. In the law of sufficient glucocorticoid treatment after 8 weeks,combined with the using of tacrolimus. Record IMN patients baseline,glucocorticoid treatment for 8 weeks and to achieve complete remission or partial remission within a weekend,the 24 h urine protein,albumin,cholesterol,creatinine. IMN patients were followed up at 12 months. By Real Time PCR method to detect PBMC of GRα mRNA and GRβ mRNA gene expression differences,and using Western blot method to detect PBMC of GRα and GRβ protein expression differences. COX regression analysis the relevance in patients with IMN in PBMC GRα/β correlation to clinical remission. Results: The follow-up study of 26 IMN patients,9 patients with CR,PR in 6 patients,11 patients with NR. RT-PCR results showed that there were lower expressions of GRα mRNA and higher expressions of GRβ mRNA in PBMC from IMN group than those in control group(P<0. 05). Western blot results showed that there were no significant change of GRα protein between IMN group and control group. But,the higher expressions of GRβ protein in PBMC from IMN group than those in control group(P<0. 05). COX regression analyses showed that clinical remission was negatively correlated with age,course of disease,hypertension,24 h urine protein,albumin,creatinine,cholesterol,triglyceride and fibrinogen. But positively correlated with the gene expression of GRα/β at baseline. Conclusion:Baseline IMN patients with GRα and GRα/β in PBMC gene expression have correlation with clinical remission.更多还原