IgA肾病、过敏紫癜性肾炎及微型多血管炎患者白介素1受体拮抗剂基因多态性分析  

Analysis of IL-1ra gene polymorphism in patients with IgA nephropathy,Henoch-Schnlein purpura nephritis,and microscopic polyangiitis

作　　者：鲍浩[1] 陈朝红[2] 张馨[2] 陈惠萍[2] 曾彩虹[2] 郑春霞[2] 张炯[2] 刘志红[2] 黎磊石[2] 

机构地区：[1]南京大学医学院临床学院 [2]南京军区南京总医院解放军肾脏病研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2007年第3期203-208,267,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:通过对IL-1受体拮抗剂(IL-1ra)基因多态性的分析,探讨IgA肾病(IgAN)的异质性以及新月体型IgAN与系统性小血管炎之间的联系。方法:随机选取200例IgAN患者、90例过敏紫癜性肾炎(HSPN)患者、45例微型多血管炎(MPA)患者及100例健康志愿者。依据解放军肾脏病研究所拟定的分型标准,将IgAN分为六型。PCR法检测样本IL-1ra基因型。分析IL-1ra基因多态性与IgAN患者临床病理特征的联系及其在不同类型IgAN患者中的分布。分析IgAN总体、新月体型(Cres.)IgAN、HSPN、MPA不同组别间IL-1ra基因多态性的异同。结果:(1)IgAN、MPA患者IL1RN*2等位基因频率和携带率与正常对照组无统计学差异,HSPN患者IL1RN*2频率和携带率显著高于正常对照组(21.1% vs 12.0%,P<0.05;40.0% vs 24.0%,P<0.05)。(2)携带IL1RN*2的IgAN患者反复肉眼血尿发生率、肉眼血尿发作间期尿红细胞≥50万/ml发生率、新月体比例、细胞型/纤维细胞型新月体比例和毛细血管袢坏死发生率显著高于IL1RN*2不携带组(P<0.05)。(3)Cres.IgAN的IL1RN*2携带率(56.3%),显著高于其它类型IgAN及正常人群。(4)HSPN患者IL1RN*2携带组新月体比例、细胞型/纤维细胞型新月体比例以及毛细血管袢坏死发生率显著高于不携带组(P<0.05)。新月体比例≥15%组IL1RN*2携带率显著高于新月体比例<15%组。(6)新月体型IgAN患者IL1RN*2携带率,无论与HSPN总体还是与新月体比例≥15% HSPN患者相比,均无统计学差异;并且与后者数值非常接近(56.3% vs 57.7%)。结论:IL1RN*2等位基因与Cres.IgAN和HSPN的发生均有关。IL1RN*2高携带率可能是Cres.IgAN和HSPN共同的遗传背景之一。Objective：To investigate whether IgA nephropathy（IgAN） or a subgroup of IgAN shares congenerous IL-1ra gene polymorphism with Henoch-Schioenlein purpura nephritis （HSPN） and microscopic polyangiitis （MPA）. Methodology：DNA was extracted from 200 patients with IgAN, 90 patients with HSPN, 45 patients with MPA and 100 healthy volunteers. The polymorphism of the variable number tandem repeat （VNTR） of IL-1 receptor antagonist （IL-1ra） gene was analyzed using PCR. The clinical and pathological features of IgAN with different genotypes were analyzed. The patients with IgAN were divided into 6 groups according to their clinicopathological manifestations. They were： crescentic （Cres. , 16 cases）, recurrent gross hematuria （R-GH, 27）, mass proteinuria （MP, 21 ）, hypertension（ HT, 42）, isolated microscopic hematuria （I-H, 5） and asymptomatic abnormal urinalysis （U-ab, 89 cases）. The distribution of IL-1ra alleles was compared among different types of IgAN, HSPN, MPA patients and normal controls. Results：There was no significant difference in the allele frequency and carriage rate of IL1 RN ＊ 2 between patients with IgAN and healthy controls.The patients carrying IL1 RN ＊ 2 showed higher incidence of R-GH, severe hematuria during the interval stage of gross hematuria, more crescent formation and increase rate of cellular/fibrocellular crescents, higher frequency of segmental glomerular necrosis than that in IgAN patients without ILl RN ＊ 2 （P 〈 0. 05 ）. The carriage rate of IL1 RN ＊ 2 was significantly higher in patients with Cres. IgAN than that in other subgroups of IgAN and normal controls （P 〈 0. 05 ）. As to HSPN patients, the allele frequency and carriage rate of IL1 RN ＊ 2 were higher than that in healthy controls, and patients carrying IL1 RN ＊ 2 also showed more crescent formation and increase rate of cellular/fibrocellular crescents, higher frequency of segmental glomerular necrosis than that in patients without IL1RN ＊ 2（P 〈0. 05）.

关 键 词：IGA肾病 过敏紫癜性肾炎 微型多血管炎 白介素1受体拮抗剂 基因多态性 

分 类 号：R692.3[医药卫生—泌尿科学]