Han Seung Hyeok, Park Sun Young, Li Jin-Ji, Kwak Seung Jae, Jung Dong Sub, Choi Hoon Young, Lee Jung Eun, Moon Sung Jin, Kim Dong Ki, Han Dae-Suk, Kang Shin-Wook
Department of Internal Medicine, College of Medicine, Brain Korea 21, Yonsei University, Seodaemoon-Gu, Seoul, Korea.
Nephrol Dial Transplant. 2008 Jan;23(1):169-75. doi: 10.1093/ndt/gfm575. Epub 2007 Sep 22.
Compared to children, adult patients with minimal change disease (MCD) tend to have a slower response to steroids, but little is known about the factors influencing the steroid responsiveness in these patients. In this study, we investigated the difference in the expression of the glomerular glucocorticoid receptor (GCR) according to steroid responsiveness in 28 adult-onset MCD patients.
Based on the response to steroid treatment, the patients were divided into early responders (ER, n=20) and late responders (LR, n=8) according to the response to steroids on the basis of 4 weeks of treatment. The clinical and laboratory findings, and the glomerular mRNA and protein expression of GCR and nephrin, assessed by real-time polymerase chain reaction and immunohistochemistry, respectively, were compared between the ER and LR groups. Ten microscopic haematuric patients in whom renal biopsy was performed and revealed no histological abnormalities were included for control (C).
The mRNA expression of GCR was significantly lower in the LR than that in the ER group (P<0.01), whereas it was comparable between the C and ER groups. GCR protein expression was also decreased in the LR compared with the C and ER groups. In contrast, there was no significant difference in nephrin mRNA expression among the three groups. On the other hand, the GCR mRNA expression correlated inversely with the time to complete remission (r= -0.49, P<0.05), but not with the amount of proteinuria at presentation.
In conclusion, the levels of glomerular GCR expression may be a useful predictor of steroid responsiveness in adult-onset MCD patients.
与儿童相比，成年微小病变病（MCD）患者对类固醇的反应往往较慢，但对于影响这些患者类固醇反应性的因素知之甚少。在本研究中，我们调查了28例成年起病的MCD患者中，根据类固醇反应性，肾小球糖皮质激素受体（GCR）表达的差异。
根据类固醇治疗反应，在治疗4周后，将患者分为早期反应者（ER，n = 20）和晚期反应者（LR，n = 8）。比较ER组和LR组的临床和实验室检查结果，以及分别通过实时聚合酶链反应和免疫组织化学评估的GCR和nephrin的肾小球mRNA和蛋白表达。纳入10例进行了肾活检且无组织学异常的显微镜下血尿患者作为对照（C）。
LR组GCR的mRNA表达明显低于ER组（P<0.01），而C组和ER组之间相当。与C组和ER组相比，LR组的GCR蛋白表达也降低。相反，三组之间nephrin mRNA表达无显著差异。另一方面，GCR mRNA表达与完全缓解时间呈负相关（r = -0.49，P<0.05），但与就诊时的蛋白尿总量无关。
总之，肾小球GCR表达水平可能是成年起病MCD患者类固醇反应性的有用预测指标。
