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目的 探讨肾病综合征 (NS)患儿肾脏局部肾素 血管紧张素系统 (RAS)、激素耐药、肾脏病理损害程度之间的关系 ,阐述激素耐药的部分机制。方法 85例原发性NS患儿按激素敏感型NS(SSNS)、激素依赖型NS(SDNS)、激素耐药型NS(SRNS)分成 3组 ,选 6例行肾切除的肾肿瘤患儿的正常肾组织作为对照组。采用原位杂交的方法检测 4组患儿肾脏原位血管紧张素转换酶 (ACE)mRNA的表达水平 ;评分法半定量评估肾脏的病理损害程度。分析NS患儿肾组织ACEmRNA表达水平、激素反应性、肾脏的病理损害程度间的关系。结果 ①在肾小球和小管间质区域的ACEmRNA表达水平均为SRNS组 >SSNS组 >对照组 (P <0 0 1)。②SRNS、SDNS、SSNS肾小球病理损害的评分分别为 :6 6 7± 2 4 3,4 6 8± 2 30 ,4 4 2± 2 87(P <0 0 1) ;小管间质病理损害评分分别为 :10 4 8± 3 77,7 2 0± 2 79,4 2 5± 1 4 8(P <0 0 1)。③肾组织ACEmRNA的表达与肾小球和小管间质病理损害程度呈正相关 ,相关系数分别为 0 4 82 ,0 85。结论 SRNS型NS患儿肾组织ACEmRNA表达增强 ,并且与肾脏的病理损害程度密切相关
Objective To investigate the relationship between renin-angiotensin system (renin-angiotensin system), steroid resistance and renal damage in children with nephrotic syndrome (NS) and to elucidate the mechanism of hormone resistance. Methods 85 primary NS children were divided into 3 groups according to hormone-sensitive NS (SSNS), hormone-dependent NS (SDNS) and hormone-resistant NS (SRNS). Six children with nephrectomy Normal kidney tissue served as control group. The in situ hybridization method was used to detect the mRNA expression of in situ renal angiotensin converting enzyme (ACE) in 4 groups of children. The grading method semi-quantitatively assessed the extent of renal pathological damage. Analyze the relationship between the expression of ACE mRNA, the hormone reactivity and the pathological damage of kidney in NS children. Results ① The expression of ACE mRNA in glomeruli and tubulointerstitial regions were all in SRNS group> SSNS group> control group (P <0.01). (2) The scores of glomerular pathological damage in SRNS, SDNS and SSNS were respectively 6 6 7 ± 2 4 3,4 6 8 ± 2 30 and 4 4 2 ± 2 87 (P 0 01); The tubulointerstitial pathological damage score Respectively: 10 4 8 ± 3 77,7 2 0 ± 2 79,4 2 5 ± 1 48 (P <0.01). ③ The expression of ACE mRNA in renal tissue was positively correlated with the degree of pathological damage of glomeruli and tubulointerstitial. The correlation coefficients were 0 4 82 and 0 85 respectively. Conclusion The expression of ACE mRNA in renal tissues of SRNS NS patients is enhanced, and it is closely related to the degree of renal pathological damage