摘要
目的检测原发性肾病综合征（ primary nephrotic syndrome, PNS ）患儿不同时间点尿液中单核细胞趋化蛋白．1（MCP-1）及IL-18的含量，探讨其与PNS的发生、发展、反复及预后有无相关性。方法选取65例初发PNS患儿为研究对象，根据对激素效应及随访结果分为三组：激素敏感型。肾病综合征（ steroid-sensitive NS, SSNS） 35例，激素耐药型肾病综合征（ steroid-resistant NS, SRNS） 15例，频反复肾病综合征（ frequent-relapse NS, FRNS） 15例。另取20例健康体检儿童作为正常对照组。分别在发病初期未用糖皮质激素时、足量激素治疗8周时、足量激素治疗16周或病情反复时采集外周血标本及尿标本。采用ELISA法检测患儿不同时间点尿液中单核细胞趋化蛋白-1（MCP-1）及IL-18的水平，并采用全自动生化分析仪测定PNS患儿不同时间点血尿素氮、肌酐及24h尿蛋白定量。结果（1）SSNS组治疗前、治疗后8周尿IL-18水平均高于对照组[治疗前（160．30±27．29）pg／ml，治疗后（157．62±26．85）pg／ml，对照组（70．88±14．43）pg／ml]；治疗16周后MCP-1、IL-18水平显著低于治疗前、治疗后8周[治疗16周（20．98±4．53）pg／ml，（79．09±7．23）pg／ml，P〈0．05]。（2）SRNS组治疗前尿MCP-1及IL-18水平显著高于SSNS组治疗前与对照组[SRNS组治疗前（76．84±5．58）pg／ml，（252．37±25．34）pg／ml，P〈0．05]，但与治疗后8周比较差异无统计学意义[治疗8周（72．32±4．30）pg／ml，（243．70±35．43）pg／ml，P〉0．05]，当联合免疫抑制剂环磷酰胺治疗16周后则显著低于治疗前、治疗后8周[治疗16周（34．03±2．56）pg／ml，（114．42±21．33）pg／ml，P均〈0．05]。（3）FRNS组治疗前、治疗后8周尿MCP-1及IL-18水平与SSNS组比较差异无统计学意义[FRNS组治疗前（30．43±4．61）pg／ml，（156．65±34．39）pg／ml，治疗8周（29．41±4．76）pg／ml，（152．21±34．73）pg／ml，P〉0．05]；但显著低于SRNS组（P〈0．05），当病情反复时，与治疗前、治疗后8周及对照组比较尿MCP-1及IL-18水平显著增高，差异有统计学意义（P〈0．05）[病情反复时（72．92±3．01）pg／ml，（224．33±26．07）pg／m1]。（4）尿MCP-1及IL-18水平与血尿素氮、肌酐之间无相关（P〉0．05），与24h尿蛋白定量呈正相关（r=0．706，0．556，P〈0．01）。尿MCP-1水平与尿IL-18水平呈正相关（r=0．811，P〈0．01）。结论PNS患儿尿MCP-1及IL-18水平的检测有助于早期预测患儿对糖皮质激素的敏感性，二者水平升高结合PNS患儿的临床症状及蛋白尿等指标可作为监测肾病反复的无创的重要指标。
Objective To investigate the concentration of monocyte chemoattractant protein -1 （ MCP-1 ） and interleukin-18 （IL-18） in the urinary of children with primary nephrotie syndrome（PNS） at different time points, and to explore their correlation with occurrence, development, progression, and prog- nosis of PNS. Methods A total of 65 pediatric cases from our hospital was enrolled in this study, and was divided into three groups based on the retrospective the follow-up results including steroid-sensitive NS （SSNS） （ n = 35）, steroid-resistant NS （SRNS） （ n = 15 ）, and frequent-relapse NS （FRNS） （ n = 15） groups. Another 20 heahhy children served as normal controls. Peripheral blood samples and urine speci-men were collected at three time points （ without glucocorticoids, treatment after 8 weeks, and treatment after 16 weeks or recurrence）. The levels of MCP-1 and IL-18 in the llrine were assayed by enzyme-linked immu- nosorbent assay （ELISA）. The levels of blood urea nitrogen, creatinine, and 24-hour urinary protein excre- tion were assayed by full-automatic biochemical study appliance. Results （Din SSNS group, the levels of urinary IL-18 before treatment and treated for 8 weeks were higher than the normal control group [ before treatment ： （ 160. 30 ± 27.29 ） pg/ml ; treated for 8 weeks ： （ 157.62 ± 26. 85 ） pg/ml ; normal control group ： （70. 88 ± 14.43 ） pg/ml ]. However, after treated for 16 weeks, the levels of urinary MCP-1 and IL-18 were markedly decreased compared with that of control group and those before treatment and treated for 8 weeks [treated for 16 weeks： （20. 98 ±4. 53） pg/ml,and （79. 09 ±7.23） pg/ml, P 〈0. 05]. （2）In SRNS group, the levels of urinary MCP-1 and IL-18 before treatment were remarkably higher than that of control group and that of SSNS group before treatment[ SSNS group before treatment： （76. 84 ± 5.58 ）pg/ml, and （252. 37 ± 25.34） pg/ml, P 〈 0.05 ], but no significant difference was found when it was compared with that treated for 8 weeks [ treated for 8 weeks ： （72. 32 ± 4. 30） pg/ml, and （243.70 ± 35.43 ） pg/ml, P 〉 0. 05 ] ; How- ever, its level was markedly decreased after treated with immunosuppressants of CTX for 16 weeks when it was compared with those before treatment and treated for 8 weeks[ treated for 16 weeks： （34. 03 ± 2. 56）pg/ ml,and （114.42 ±21.33）pg/ml, P 〈 0. 05 ]. （3）In FRNS group, the levels of urinary MCP-1 and IL-18 were no remarkable difference between control and SSNS groups [ before treatment： （30. 43 ± 4. 61 ）pg/ml, and （ 156. 65 ± 34. 39 ） pg/ml ; treated for 8 weeks ： （29.41 ± 4. 76） pg/ml, and （ 152. 21 ± 34. 73 ） pg/ml, P 〉 0. 05 ] , but its level was markedly lower than SRNS group （ P 〈 0. 05 ）. When it was recurred, the levels of urinary MCP-1 and IL-18 were significantly increased compared with before treatment and treated for 8 weeks[ recurred ： （72. 92 ± 3.01 ） pg/ml, and （224. 33 ± 26. 07 ） pg/ml, P 〈 0. 05 ]. （4）No correlation was found between the levels of MCP-1 and IL-18 and the levels of blood urea nitrogen and creatinine （ P 〉 0. 05 ）. Positive correlation was found between the levels of MCP-1 and IL-18 and the 24-hour urinary pro- tein excretion （ r =0. 706,0. 556, P 〈0. 01 ）. There＇s a correlation between urinary MCP-1 and IL-18 （ r = 0. 811, P 〈 0. 01 ）. Conclusions For children with PNS, the detection of urinary MCP-1 and IL-18 con- tributed to the early prediction of children sensitivity on glucocorticoid. The elevated levels of urinary MCP- 1 and IL-18 in combination with clinical symptoms and proteinaria can be used as an important noninvasive marker to monitor PNS recurrence.
出处
《中国医师杂志》
CAS
2013年第5期621-625,共5页
Journal of Chinese Physician
