糖皮质激素受体α、β mRNA在婴幼儿喘息患儿中的表达及临床意义  

Clinical significance and expression of glucocorticoid receptor α,β mRNAs in infant wheezing

作　　者：姚欢银[1] 马兰[1] 董虹[1] 童海明[1] 王小仙[1] 陈啸洪[1] 刘淑梅[1] YAO Huan-yin;MA-Lan;DONG-Hong;TONG Hai-ming;WANG Xiao-xian;CHEN Xiao-hong;LIU Shu-mei(Department of Pediatrics Shaoxing People's Hospital Zhejiang Province,Shaoxing Hospital Zhejiang University,Shaoxing,Zhejiang 312000,China)

机构地区：[1]绍兴市人民医院浙江大学绍兴医院儿内科,浙江绍兴312000

出　　处：《中华全科医学》2020年第2期258-261,共4页Chinese Journal of General Practice

基　　金：浙江省医药卫生一般研究计划项目A类(2015KYA219)。

摘　　要：目的研究婴幼儿喘息患儿外周血单个核细胞(peripheral blood mononuclear cells,PBMC)中糖皮质激素受体(glucocorticoid receptor,GR)αmRNA和GRβmRNA表达水平的变化,为选择性应用糖皮质激素(glucocorticoid,GC)和早期干预提供实验依据。方法选取2015年9月-2018年1月绍兴市人民医院儿内科住院的50例婴幼儿喘息(重症19例)和25例对照组进行研究。研究对象入院后次日晨空腹抽取静脉血2 mL,采用Ficoll密度梯度离心法分离PBMC,逆转录-聚合酶链反应(RT-PCR)法检测PBMC中GRαmRNA和GRβmRNA表达量。结果婴幼儿喘息重度组GRαmRNA表达量显著高于对照组(中位数2.870×10^-2 vs. 0.266×10^-2,U=2.204,P=0.028),与轻度组(中位数0.865×10^-2)比较差异无统计学意义(U=0.650,P=0.516);重度组GRβmRNA表达量(中位数0.057×10^-2)显著高于轻度组和对照组(中位数0.003×10^-2、0.001×10^-2),差异有统计学意义(U=3.388,P<0.001;U=3.969,P<0.001);重度组GRα/β比值(中位数25.900×10^-2)显著低于轻度组和对照组(中位数780.800×10^-2,U=2.708,P=0.007;98.000×10^-2,U=2.192,P=0.028),恢复期GRα/β比值(中位数253.500×10^-2)较急性期(中位数51.100×10^-2)显著升高(U=2.084,P=0.037)。临床症状严重度评分与GRβmRNA之间存在显著正相关(r=0.762,P=0.029),与GRα/β比值之间存在显著负相关(r=-0.760,P=0.037)。结论重度婴幼儿喘息主要表现为GRβmRNA表达量增加,GRα/β比值降低。随着临床症状评分的升高,GRβmRNA表达量增加,GRα/β比值下降。Objective To study the changes of the expression of GRα, β mRNAs in peripheral blood mononuclear cells(PBMC) and provide scientific basis for the selective application of GC and early rational intervention in infant wheezing. Methods All subjects were taken 2 mL peripheral venous blood to separate PBMC in the morning after admission. PBMC was separated by Ficoll-Hypaque method. The expression levels of GRαand GRβ mRNAs in PBMC were identified by RT-PCR. Results The expression of GRα mRNA in severe cases were significantly higher than that in the control group(median value 2.870×10^-2 vs. 0.266×10^-2,U=2.204, P=0.028), and no significant difference compared with the mild group(median value 0.865×10^-2, U=0.650, P=0.516). The expression of GRβ mRNA in severe group was significantly higher than that in mild group and control group(median value 0.057×10^-2 vs. 0.003×10^-2 vs. 0.001×10^-2, U=3.388, P<0.001;U=3.969, P<0.001). The ratio of GRα/β in severe group was significantly lower than that in mild group and control group(median value 25.900×10^-2 vs. 780.800×10^-2 vs. 98×10^-2, U=2.708, P=0.007;U=2.192, P=0.028), while in recovery phase was significantly higher than in acute stage(median value 253.500×10^-2 vs. 51.100×10^-2, U=2.084, P=0.037). There was a significant positive correlation between clinical severity score and GRβmRNA(r=0.762, P=0.029), and a significant negative correlation with GRα/β ratio(r=-0.760, P=0.037). Conclusion The expression of GR is mainly showed the increase of GRβmRNA and the decrease of GRα/βratio in severe children. With the increase of clinical symptom score, the expression of GRβmRNA increased, and the ratio of GRα/β decreased in infant wheezing.

关 键 词：婴幼儿喘息 糖皮质激素受体 外周血单个核细胞 逆转录-聚合酶链反应 

分 类 号：R725.6[医药卫生—儿科] R446[医药卫生—临床医学]