Study Of MRNA Expression Of Glucocorticoid Receptor And Treatment With Glucocorticoid In Children Nephrotic Syndrome

Objective:Observe the mRNA expression levels of GRa and GRB during the treatment of children PNS to explore the relation between GR subtypes and children PNS, thus evaluate the efficacy of three GC drugs through mRNA expression changes of GR subtypes as well as changes of various clinical indicators.Methods:The research subjects are 55 PNS kid patients. They are randomly divided into three groups, namely, prednisone group (GroupA=17), triamcinolone group (GroupB=20), methylprednisolone group (GroupC=18) to compare with 20 healthy children. After GC application, collect blood after 0 week,4 weeks and 8 weeks; test the mRNA expression levels of the GR subtypes in PBMCs by semi-quantitative RT-PCR; meanwhile, test changes in the Cho,Alb and 24hUP of PNS children, record the response to hormone therapy and make follow-up prognosis.Results:1. Changes in mRNA expression levels of GRa and GRB.1) Comparison of changes in mRNA expression levels of GRa and GRB between PNS children and healthy children, a) In 0 week of receiving GC treatment, the GRa of PNS children is lower than healthy children (P＜0.05); the GRB of PNS children is higher than healthy children and the difference is statistically significant (P＜0.05).b) After 4 weeks'GC treatment, the GRa of PNS children is lower than that of 0 week (P＜0.05);After 8 weeks' GC treatment, the GRa of PNS children is higher than that of 4 week (P＜0.05).As the treatment time increases, the overall GRβlevel is rising and the difference is statistically significant (P＜0.05).2) Changes of mRNA levels in GRa and GRB of each PNS children group.a) In 0 week of receiving GC treatment, the comparison of changes of mRNA levels in GRa and GRB of the three PNS children groups has no statistical significance (P＞0.05).b) After 4 weeks' and 8 weeks' treatment, the GRa comparison difference between Group A and Group B has no statistical significance (P＞0.05), the GRa of Group C is higher than that of Group A and Group B, the difference is statistically significant (P＜0.05).c) After 4 weeks'and 8 weeks'treatment, the GRB comparison difference of Group B and Group C has no statistical significance (P＞0.05);the GRB of Group B and Group C is lower than that of Group A, the difference is statistically significant (P＜0.05);.3) There are 6 cases of PNS children steroid-resistance; in the treatment of 0,4 and 8 weeks, the GRa of them is lower than steroid-sensitive children and GRB is higher(P＜0.05).2. Changes in various biochemical indicators:With GC treatment, cho decreases;Alb increases;24hUP decreases and the difference is statistically significant(P＜0.05).1)Cho:the difference among the three PNS groups has no statistical significance(P＞0.05).2) Alb:after 4 weeks'and 8 weeks'treatment, the comparison difference between Group B and Group C is not statistically significant (P＞0.05); Group C and Group B is higher than Group A(P＜0.05).3)24hUP:after 4 weeks'and 8 weeks' treatment, the comparison difference between Group B and Group C is not statistically significant (P＞0.05),Group C and Group B is lower than Group A(P＜0.05).Conclusions:1. Abnormities are found in the mRNA expression of GRa and GRB of PNS children, and the mRNA expression disorder of GRa and GRB of PNS children may be one of the reasons causing GC resistance.2. GC treatment on PNS children can adjust the mRNA expression of GRa and GRB. Different GC adjustments have different degrees on mRNA expression of GRa and GRB.and the adjusting level can evaluate the efficacy of GC.3. By semi-quantitative RT-PCR, we can test the mRNA expression levels of the GR subtypes in PBMCs. RT-PCR can be used into clinical test, to evaluate the efficacy of GC drugs and predict the PNS children's treatment effect and prognosis.4.Oral methylprednisolone can be used in children onset PNS. Methylprednisolone and triamcinolone have a better treatment effect on PNS than that of prednisone.