白细胞介素18在激素耐药型肾病综合征外周血单个核细胞中的表达及意义

Interleukin-18 expression in peripheral blood mononuclear cells in children with steroid-resistant nephrotic syndrome

摘要:

目的：通过研究原发性肾病综合征（PNS）患儿血清白细胞介素18（IL-18）水平及其在外周血单个核细胞（PBMC）中的表达，探讨IL-18在激素耐药型肾病综合征（SRNS）发生、发展中的可能机制。方法：采用ELISA法及RT-PCR法测定40例正常儿童及39例激素敏感型肾病综合征（SSNS）、27例 SRNS血清IL-18蛋白水平及PBMC mRNA表达。双缩脲法检测24 h尿蛋白量。全自动生化分析仪检测血清总胆固醇（T-Ch）、甘油三酯（TG）、低密度脂蛋白(LDL)、总蛋白（TP）及白蛋白（Alb）含量。结果：①与正常对照组相比，治疗前SSNS、SRNS血清IL-18蛋白水平及PBMC IL-18 mRNA表达均明显增高（P<0.05）；与SSNS相比，SRNS上述指标均增高（P<0.05）；SSNS及SRNS之间血清Alb，TP，T-Ch，TG水平及 24 h 尿蛋白量差异无显著性（P>0.05），SRNS血清LDL水平较SSNS高（P<0.05）。②治疗后SRNS组血清IL-18蛋白水平及PBMC IL-18 mRNA表达均高于SSNS组及正常对照组（P<0.05）；SSNS 组与正常对照组比较差异无显著性（P>0.05）。③治疗后SSNS组血清IL-18蛋白水平及PBMC IL-18 mRNA表达较治疗前明显下降（P<0.05）。而SRNS 组治疗前、后无明显变化（P>0.05）。结论：PNS 激素耐药与 IL-18血清水平及PBMC mRNA表达明显升高有关，IL-18 的过度分泌在SRNS的发生发展中发挥一定作用。［中国当代儿科杂志，2009，11（5）：337-340］

Abstract:

OBJECTIVE: To examine serum concentration of interleukin-18 (IL-18) and IL-18 mRNA expression in peripheral blood mononuclear cells (PBMCs) in children with primary nephrotic syndrome (PNS) and explore the possible role of IL-18 in steroid-resistant nephrotic syndrome (SRNS). METHODS: Sixty-six children with newly diagnosed PNS, including 39 cases of steroid sensitive nephrotic syndrome (SSNS) and 27 cases of SRNS, were enrolled. Forty healthy children were used as a normal control group. Blood samples were collected before and 8 weeks after glucocorticoid treatment. Serum concentration of IL-18 was measured using ELISA. IL-18 mRNA expression in PBMCs was detected by the RT-PCR method. The amount of 24-hr urine protein was measured by the biuret method. Serum contents of total cholesterol (T-Ch), triglyceride (TG), low density lipoprotein (LDL), total protein (TP), and albumin (Alb) were measured by the automatic biochemistry analyzer. RESULTS: Serum concentration of IL-18 and IL-18 mRNA expression in PBMCs in the SSNS and the SRNS groups were significantly higher than those in the normal control group before treatment (P<0.05). The SRNS group had increased serum protein concentration of IL-18 and IL-18 mRNA expression in PBMCs compared with the SSNS group before treatment (P<0.05). Serum LDL content in the SRNS group was also significantly higher than that in the SSNS group before treatment (P<0.05). After treatment, serum concentration of IL-18 and IL-18 mRNA expression in PBMCs in the SRNS group were significantly higher than those in the SSNS and the normal control groups (P<0.05). Serum concentration of IL-18 and IL-18 mRNA expression in PBMCs in the SSNS group were significantly reduced after treatment, but the alterations of IL-18 were not observed in the SRNS group after treatment. CONCLUSIONS: SRNS was associated with increased serum IL-18 concentration and IL-18 mRNA expression in PBMCs. Over-production of IL-18 may play a role in the development of SRNS.［Chin J Contemp Pediatr, 2009, 11 (5):337-340］