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血液中可溶性及细胞表面肿瘤坏死因子受体在儿童肾病综合征中的意义

Implications of blood soluble and cell surface tumor necrosis factor receptors in childhood nephrotic syndrome.

作者信息

Tain You-Lin, Liu Chieh-An, Yang Kuender D

机构信息

Division of Pediatric Nephrology, Chang Gung Children's Hospital, Kaohsiung, Taiwan.

出版信息

Pediatr Nephrol. 2002 Nov;17(11):926-32. doi: 10.1007/s00467-002-0994-z. Epub 2002 Oct 29.

Abstract

We investigated whether leukocyte cell surface TNF receptors (cTNFR) and plasma soluble TNF receptors (sTNFR) could serve as predictors of childhood steroid-resistant nephrotic syndrome (SRNS) during the early stage of diagnosis. We recruited 39 nephrotic children for studies correlating plasma sTNFR and leukocyte cTNFR with disease activity and therapeutic response. We found that patients with idiopathic childhood nephrotic syndrome (NS) had higher pre-treatment plasma sTNFR1 ( P<0.001) and sTNFR2 levels ( P<0.001) than controls without NS. In contrast, cTNFR1 ( P<0.001) and cTNFR2 ( P=0.014) expression on granulocytes but not lymphocytes was lower in patients than controls. Patients with SRNS, similar to steroid-sensitive nephrotic syndrome (SSNS), had higher sTNFR1 and sTNFR2 levels pre treatment. However, patients with SRNS revealed higher expression of cTNFR1 ( P<0.001) and cTNFR2 ( P=0.023) than those with SSNS. After 4 weeks of steroid treatment, plasma sTNFR1 and sTNFR2 levels returned to normal in both patients with SRNS and SSNS. Post treatment, the decreased cTNFR1 and cTNFR2 expression on granulocytes in patients with SSNS returned to normal, while patients with SRNS revealed no change before and after treatment. This study suggests that a higher plasma sTNFR level associated with lower cTNFR expression reflects NS disease activity, whereas a higher initial granulocyte cTNFR expression tends to predict steroid resistance. TNFR may play a pathophysiological role in childhood NS.

摘要

我们研究了白细胞细胞表面肿瘤坏死因子受体(cTNFR)和血浆可溶性肿瘤坏死因子受体(sTNFR)能否作为儿童激素抵抗型肾病综合征(SRNS)早期诊断的预测指标。我们招募了39名肾病患儿,研究血浆sTNFR和白细胞cTNFR与疾病活动度及治疗反应的相关性。我们发现,特发性儿童肾病综合征(NS)患者治疗前血浆sTNFR1(P<0.001)和sTNFR2水平(P<0.001)高于无NS的对照组。相比之下,患者粒细胞而非淋巴细胞上的cTNFR1(P<0.001)和cTNFR2(P=0.014)表达低于对照组。与激素敏感型肾病综合征(SSNS)患者相似,SRNS患者治疗前sTNFR1和sTNFR2水平较高。然而,SRNS患者的cTNFR1(P<0.001)和cTNFR2(P=0.023)表达高于SSNS患者。激素治疗4周后,SRNS和SSNS患者的血浆sTNFR1和sTNFR2水平均恢复正常。治疗后,SSNS患者粒细胞上降低的cTNFR1和cTNFR2表达恢复正常,而SRNS患者治疗前后无变化。本研究表明,较高的血浆sTNFR水平与较低的cTNFR表达相关反映了NS的疾病活动度,而较高的初始粒细胞cTNFR表达倾向于预测激素抵抗。TNFR可能在儿童NS中发挥病理生理作用。

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