IgA肾病患者肾小球中糖皮质激素受体表达与治疗反应性的临床研究  

Clinical Study of Glucocorticoid Receptor Expression and Therapeutic Response in Glomerular of Patients with IgA Nephropathy

作　　者：梁婷玉[1] 杨华[1] 冯真[1] 沈沛成[2] LIANG Tingyu;YANG Hua;FENG Zheng(Department of Nephrology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,210001)

机构地区：[1]上海中医药大学附属曙光医院病理科,上海210001 [2]上海中医药大学附属曙光医院肾病科,上海210001

出　　处：《中国中西医结合肾病杂志》2023年第6期502-505,I0003,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：上海市卫生健康委员会基金资助项目(No.20204Y0191);上海中医药大学附属曙光医院临床项目(No.20204Y0191)。

摘　　要：目的:观察IgA肾病患者肾活检组织中糖皮质激素受体的表达水平,探讨其与糖皮质激素治疗有效性的关系。方法:选取2018年01月—2022年03月148例IGAN患者,其中82例接受个体化糖皮质激素治疗的IgA肾病患者符合研究纳入标准,收集临床和病理资料,分析其治疗效果,比较不同疗效组患者的临床指标和病理肾活检组织中的糖皮质激素受体表达水平。结果:患者平均年龄为(35.89±9.95)岁,其中男性患者占比为51.22%,82例患者均对糖皮质激素治疗有反应,根据疗效分为完全缓解组(CR组)和非完全缓解组(非CR组)分别为31例(37.8%)和51例(62.2%),通过实时聚合酶链反应法(RT-PCR法)及免疫组织化学法评估肾小球糖皮质激素受体(GCR)表达水平。不同疗效患者治疗前的性别、年龄、平均动脉压、24 h尿蛋白定量、肌酐、尿素氮、估计肾小球滤过率、血浆白蛋白、胆固醇、三酰甘油、尿酸、血红蛋白水平比较,差异无统计学意义(P>0.05)。不同疗效患者肾组织的系膜细胞增生(M)、肾小球节段硬化或黏连(S)积分比较,差异无统计学意义(P>0.05);患者内皮细胞增殖(E)、肾小管萎缩或间质纤维化(T)积分比较,差异有统计学意义(P<0.05)。RT-PCR法及免疫组织化学法均证实,CR组的肾小球GCR表达较非CR组高(P<0.01)。结论:这项研究表明,糖皮质激素的疗效可能与肾小球GCR在IgA肾病中的表达程度有关。Objective:To observe the expression level of glucocorticoid receptor in renal biopsy tissues of patients with IgA nephropathy,and explore the relationship between the expression level and the effectiveness of glucocorticoid therapy.Methods:A total of 148 IGAN patients were selected from January 2018 to 2022,among which 82 IgA nephropathy patients receiving individualized glucocorticoid therapy met the study inclusion criteria.Clinical and pathological data were collected to analyze the treatment effect,and the clinical indicators of patients with different efficacy groups and the glucocorticoid receptor expression levels in pathological renal biopsy tissues were compared.Results:The mean age of the patients was 35.89±9.95,among which the proportion of male patients was 51.22%.All 82 patients responded to glucocorticoid treatment,and were divided into complete remission group(CR group)and incomplete remission group(non-CR group)according to the efficacy,31 cases(37.8%)and 51 cases(62.2%)respectively.Glomerular glucocorticoid receptor(GCR)expression was assessed by real-time polymerase chain reaction(RT-PCR)and immunohistochemistry.There were no significant differences in gender,age,mean arterial pressure,24 h urinary protein,creatinine,urea nitrogen,estimated glomerular filtration rate,plasma albumin,cholesterol,triglyceride,uric acid and hemoglobin levels among patients with different therapeutic effects before treatment(P>0.05).There was no significant difference in the scores of mesangial cell proliferation(M)and glomerular segmental sclerosis or adhesion(S)among patients with different therapeutic effects(P>0.05).The scores of endothelial cell proliferation(E),renal tubule atrophy or interstitial fibrosis(T)were statistically significant(P<0.05).Rt-pcr and immunohistochemistry confirmed that the glomerular GCR expression in CR group was higher than that in non-CR group(P<0.01).Conclusion:This study suggests that the response to glucocorticoid therapy may be related to the degree of GCR expression in IgA nephr

关 键 词：IGA肾病 肾穿刺活检 糖皮质激素受体表达 

分 类 号：R692.31[医药卫生—泌尿科学]