原发性肾病综合征患者足细胞中糖皮质激素受体α和β的表达与激素敏感性的相关分析  

Correlation of expression of Glucocorticoid Receptor α and β in podocytes with sensitivity of glucocorticoid in primary nephrotic syndrome

作　　者：谢华[1] 林洪丽[1] 陈吉林[1] 康喆[1] 王伟东[1] 陈淑妮[1] 

机构地区：[1]大连医科大学附属第一医院肾内科,辽宁大连116011

出　　处：《中国现代医学杂志》2012年第36期35-39,共5页China Journal of Modern Medicine

摘　　要：目的探讨原发性肾病综合征患者足细胞中糖皮质激素受体(GR)α和β的表达与激素敏感性的相关性。方法 62例原发性肾病综合征患者进行常规肾活检,应用电镜观察足细胞形态,免疫组化检测足细胞计数的标志物WT-1和足细胞中糖皮质激素受体(GR)α及β的表达,同时选取因肾癌行肾切除的10例患者的肾脏病理切片作为对照组。足量激素治疗4周后,根据蛋白尿减少的程度分为激素敏感组(n=30)和激素不敏感组(n=32),分析糖皮质激素受体(GR)α及β的表达与激素敏感性的相关性。结果激素不敏感组单个肾小球足细胞计数较激素敏感组显著减少(P<0.05),且电镜下足细胞损伤较重。激素不敏感组的GRα阳性的足细胞计数和足细胞上GRα/β比例较激素敏感组显著降低,GRβ阳性的足细胞计数较激素敏感组显著增加(P<0.05)。GRα、GRβ阳性的足细胞计数及GRα/β比例的ROC曲线下面积分别为0.549、0.612和0.741,在GRα/βROC曲线上选择兼顾敏感性和特异性的最佳cutoff值为4.8。结论原发性肾病综合征患者足细胞损伤程度有助于预测激素的敏感性,足细胞中GRα/β比例低于4.8提示激素不敏感。[ Objective ] To investigate the relationship between the expression of Glucocorticoid Receptor （GR） α and 13 in podocytes and the sensitivity of glucocortieoid in patients with primary nephrotic syndrome. [Methods] 62 primary nephrotic syndrome patients who received renal biopsy were enrolled, all of them had been prescribed with glueocortieoid for at least 4 weeks and divided into two groups, steroid-sensitive group （n =30） and steroid-insensitive group （n=32） according to the therapeutic efficacy of glueocorticoid. Podocytes were identified by electron microscope and immunohistological staining of WT-1, a characteristic marker for podocyte nuclei, and GRα/β. [Resuits] Severe podocyte injury, absence of podocyte numbers in simple glomerulus were found in steroid-insensitive group （P 〈0.05）. Podocyte numbers of GR α positive and the ratio of GR α/β in steroid-insensitive group decreased compared with steroid-sensitive group. Podocyte numbers of GR β positive in simple glomerulus in steroid-insensi- tive group increased compared with steroid-sensitive group （P 〈0.05）. Area under the ROC curve of podocyte numbers of GR α, GR β positive in simple glomerulus and the ratio of GR α/β were respectively 0.352, 0.549 vs 0.701, the best cutoff value was 4.8 on GR α/β ROC curve. [Conclusions] Podocyte injury in patients with primary nephrotie syndrome can predict the sensitivity of glueocorticoid. It can indicate the poor sensitivity of glucocorticoid as the ratio of GRα/β in podocyte was less than 4.8.

关 键 词：糖皮质激素受体亚型 足细胞 原发性肾病综合征 激素敏感性 

分 类 号：R692.3[医药卫生—泌尿科学]