Toll-like Receptor 9 Expression And The Effect Of Glucocorticoid Treatment In Children With IgA Nephropathy

Objective:(1)To detect the expression of TLR9-m RNA and protein in peripheral blood mononuclear cells of children with IgA nephropathy and the level of urinary erythrocyte count,plasma albumin,serum IgA and urinary protein.(2)To observe the changes of expression of TLR9-m RNA and protein before and after prednison therapy in children with IgA nephropathy with different clinical manifestations.To investigate the possible relationship between the efficacy of prednison therapy for IgA nephropathy and the expression of TLR9 in children with IgA nephropathy.Methods: 45 cases of IgA nephropathy were divided into three groups according to clinical symptoms: hematuria group,mild proteinuria group,moderate proteinuria group,hematuria group were treated with anticoagulation,keeping kidney and other symptomatic treatment,mild Proteinuria group,moderate proteinuria group were added to the group of hematuria on the basis of small dose of prednison and moderate dose of prednison therapy or even pulse treatment,before treatment,7 days after treatment,15 days routine detection of IgAN children with clinical indicators : Urine erythrocyte count,plasma albumin,serum IgA,urinary protein and peripheral blood mononuclear cells(PBMCs)TLR-9 gene and protein expression.Results:1.The expression of TLR-9 gene and protein in the patients with hematuria,mild proteinuria and moderate protein were significantly higher than those in healthy children(P <0.05),but there was no significant difference between serum IgA level and urine red blood cell count.(p> 0.05).2.7 days of treatment,hematuria group of24-hour urinary protein,serum IgA,TLR-9 expression,urine red blood cell count was significantly lower than those without,serum albumin levels slightly increased,compared with before treatment were not statistically significant(p>0.05).Mild proteinuria group of 24-hour urinary protein,serum IgA,TLR-9 expression,urine redblood cell count decreased slightly,slightly increased serum albumin level,than before treatment were not statistically significant(p> 0.05);in degree of proteinuria above serum IgA,TLR-9 expression,urine red blood cell count significantly decreased serum albumin levels increased significantly,but were not statistically significant(p> 0.05);24-hour urine protein than before treatment decreased,with statistical significance(p<0.05);3.Treatment for 15 days,hematuria group of 24-hour urinary protein,serum IgA,TLR-9 expression,urine red blood cell count decreased serum albumin levels increased,compared to before treatment was not statistically significant(p> 0.05);Mild proteinuria before the 24-hour urine protein excretion decreased significantly compared with before treatment,serum albumin level increased significantly compared with before treatment were statistically significant(p <0.05),serum IgA,TLR-9 expression,urine and red blood cell count before treatment was no significant decrease was not statistically significant(p> 0.05);Moderate and proteinuria above 24-hour urine protein excretion,TLR-9 expression compared to the previous treatment with significant serum albumin levels increased significantly,were statistically significant(p <0.05),serum IgA levels of red blood cells in urine decline compared with the count before treatment,was not statistically significant(p> 0.05).Conclusion:(1)TLR9 gene and protein are highly expressed in IgA nephropathy,and the expression level of TLR9 is positively correlated with the degree of renal pathological damage,which may be involved in the pathogenesis of IgA nephropathy.(2)There was no significant correlation between TLR9 gene and protein expression level and serum IgA level and erythrocyte count in IgA nephropathy,and it was linearly correlated with 24 h urinary protein quantification and negatively correlated with serum albumin level.The expression of TLR9 gene and protein in children with IgA nephropathy may be related to the formation of proteinuria.(3)in the observation of hormone treatment of mild proteinuria and moderate proteinuria IgA nephropathy in children can be found,with the treatment time,childrengradually reduce the degree of proteinuria,the body's TLR9 expression also decreased,indicating that TLR9 in IgA nephropathy in children can be used as an effective indicator of the evaluation of hormone efficacy,but also for the treatment of IgA nephropathy in the specific mechanism of action provides a research direction.