目的探讨检测外周血转化生长因子（TGF）-β1和白介素（IL）-18 mRNA表达水平对于儿童原发性肾病综合征（PNS）激素耐药的临床意义。方法对2012年11月至2013年10月天津市儿童医院PNS组患儿分别在激素治疗前、治疗1周、治疗4周取血,纳入...目的探讨检测外周血转化生长因子（TGF）-β1和白介素（IL）-18 mRNA表达水平对于儿童原发性肾病综合征（PNS）激素耐药的临床意义。方法对2012年11月至2013年10月天津市儿童医院PNS组患儿分别在激素治疗前、治疗1周、治疗4周取血,纳入正常对照组儿童取血。通过RT-PCR检测外周血单个核细胞（PBMC）中TGF-β1和IL-18mRNA的表达水平。结果在激素治疗前、1周、4周时,激素敏感型肾病综合征（SRNS）组TGF-β1和IL-18 m RNA的水平均高于激素耐药型肾病综合征（SSNS）组（P〈0.05）。正规激素治疗1周、4周后,SSNS组TGF-β1和IL-18 mRNA的水平随时间均逐渐下降（P〈0.05）。SRNS组经正规激素治疗1周时,TGF-β1mRNA的水平比激素治疗前降低（P〈0.05）。与治疗1周时比较,SRNS组治疗4周时,IL-18 m RNA降低（P〈0.05）。受试者工作特征曲线（ROC）分析,PBMC中TGF-β1、IL-18 m RNA在诊断SRNS的ROC曲线下面积0.89和0.68。诊断临界点分别为0.44和0.13,其对应灵敏度分别为82.6%和65.2%,特异度分别为83.3%和72.2%。结论在儿童PNS开始激素治疗的1~4周,PBMC中TGF-β1、IL-18 mRNA的表达水平持续增高,提示PNS患儿有发生激素耐药的风险。在激素应用前,当PBMC中TGF-β1mRNA的表达量≥0.44时应警惕PNS患儿出现激素耐药。展开更多
Objective This study aimed to investigate the long-term outcomes in children with steroid-resistant nephrotic syndrome （SRNS）, who received methylprednisolone pulse therapy （MPT）-based sequential steroid therapy. ...Objective This study aimed to investigate the long-term outcomes in children with steroid-resistant nephrotic syndrome （SRNS）, who received methylprednisolone pulse therapy （MPT）-based sequential steroid therapy. In particular, we aimed to observe whether these patients had a high risk of adverse events. Methods We conducted a retrospective study over a 5-year period. The long-term outcomes for children with SRNS receiving sequential therapy were observed. Results Sixty-three children were diagnosed with SRNS and underwent MPT-based sequential steroid therapy. Thirty-five （55.6%） achieved complete or partial remission, 19 （30.2%） of whom were in remission even after treatment cessation at last review. The mean time to initial remission after MPT was 24.3±13.1 days. Forty-nine children （77.8%） experienced relapses, of whom 31 （49.2%） demonstrated a frequent relapsing course. Adverse effects relevant to MPT were generally mild and infrequent. Five patients （7.9%） complained of vomiting or nausea during MPT infusion; 25 （39.7%） experienced excessive weight gain and developed an obvious Cushingoid appearance; and 26 （41.3%） had poor growth associated with long-term steroid use. Twenty-eight patients （44.4%） failed to respond to MPT, of whom 21 （33.3%） achieved complete or partial remission with immunosuppressive agents. Conclusion MPT-based sequential steroid therapy appears to be a safe and effective method for inducing rapid remission in childhood SRNS. Further clinical studies are needed to comprehensively evaluate this therapy.展开更多
文摘目的探讨检测外周血转化生长因子（TGF）-β1和白介素（IL）-18 mRNA表达水平对于儿童原发性肾病综合征（PNS）激素耐药的临床意义。方法对2012年11月至2013年10月天津市儿童医院PNS组患儿分别在激素治疗前、治疗1周、治疗4周取血,纳入正常对照组儿童取血。通过RT-PCR检测外周血单个核细胞（PBMC）中TGF-β1和IL-18mRNA的表达水平。结果在激素治疗前、1周、4周时,激素敏感型肾病综合征（SRNS）组TGF-β1和IL-18 m RNA的水平均高于激素耐药型肾病综合征（SSNS）组（P〈0.05）。正规激素治疗1周、4周后,SSNS组TGF-β1和IL-18 mRNA的水平随时间均逐渐下降（P〈0.05）。SRNS组经正规激素治疗1周时,TGF-β1mRNA的水平比激素治疗前降低（P〈0.05）。与治疗1周时比较,SRNS组治疗4周时,IL-18 m RNA降低（P〈0.05）。受试者工作特征曲线（ROC）分析,PBMC中TGF-β1、IL-18 m RNA在诊断SRNS的ROC曲线下面积0.89和0.68。诊断临界点分别为0.44和0.13,其对应灵敏度分别为82.6%和65.2%,特异度分别为83.3%和72.2%。结论在儿童PNS开始激素治疗的1~4周,PBMC中TGF-β1、IL-18 mRNA的表达水平持续增高,提示PNS患儿有发生激素耐药的风险。在激素应用前,当PBMC中TGF-β1mRNA的表达量≥0.44时应警惕PNS患儿出现激素耐药。
文摘目的:探讨NF-κB与溃疡性结肠炎(UC)发病关系及其在激素抵抗中的意义．方法:选择活动期中度以上UC患者35例,均予强的松治疗(20-40 mg/d)4 wk．根据治疗反应分为激素敏感组和激素耐药组,均作为实验组,检测激素治疗前、治疗后结肠病变黏膜组织中的NF-κB表达水平．设立正常对照组 16例．结果:在激素治疗前,激素敏感组、激素抵抗组NF-κB p65表达水平分别与正常对照组比较,差异有显著性(5．9±2．7,6．1±2．9 vs 1.1± 0．8,P<0．01)．在激素治疗前,激素敏感组和激素抵抗组之间比较,差异无显著性(P>0．05)．在激素治疗后,激素敏感组和激素抵抗组之间比较,差异有显著性(1．3±0．8 vs 5．4± 2．4,P<0．01)．在激素治疗前后,激素敏感组自身比较,差异有显著性(5．9±2．7 vs 1．3±0．8, P<0．01)．而激素抵抗组在前后结果的比较中, 差异无显著性(P>0．05)．结论:NF-κB与UC关系密切,在UC的发病机制中起重要作用．NF-κB在激素治疗前后的变化有助于判断UC患者是否对激素抵抗,可以作为进一步预测激素抵抗的一个较早期的诊断指标．
文摘Objective This study aimed to investigate the long-term outcomes in children with steroid-resistant nephrotic syndrome （SRNS）, who received methylprednisolone pulse therapy （MPT）-based sequential steroid therapy. In particular, we aimed to observe whether these patients had a high risk of adverse events. Methods We conducted a retrospective study over a 5-year period. The long-term outcomes for children with SRNS receiving sequential therapy were observed. Results Sixty-three children were diagnosed with SRNS and underwent MPT-based sequential steroid therapy. Thirty-five （55.6%） achieved complete or partial remission, 19 （30.2%） of whom were in remission even after treatment cessation at last review. The mean time to initial remission after MPT was 24.3±13.1 days. Forty-nine children （77.8%） experienced relapses, of whom 31 （49.2%） demonstrated a frequent relapsing course. Adverse effects relevant to MPT were generally mild and infrequent. Five patients （7.9%） complained of vomiting or nausea during MPT infusion; 25 （39.7%） experienced excessive weight gain and developed an obvious Cushingoid appearance; and 26 （41.3%） had poor growth associated with long-term steroid use. Twenty-eight patients （44.4%） failed to respond to MPT, of whom 21 （33.3%） achieved complete or partial remission with immunosuppressive agents. Conclusion MPT-based sequential steroid therapy appears to be a safe and effective method for inducing rapid remission in childhood SRNS. Further clinical studies are needed to comprehensively evaluate this therapy.
