小儿原发性肾病综合征足量糖皮质激素治疗前后血尿白介素-6检测及其临床意义

目的：白介素-6(IL-6)是原发性肾病综合征有肯定意义的细胞因子之一。该文探讨原发性肾病综合征患儿足量糖皮质激素治疗前后血、尿白细胞介素-6水平变化及其临床意义。方法：初治的原发性肾病综合征患儿38例,分别于足量激素治疗前和足量激素治疗8周后(或尿蛋白转阴2周后)用ELISA方法检测血、尿中白细胞介素-6的水平。比较激素敏感组和激素耐药组血、尿白细胞介素-6的含量。结果：激素治疗前,激素敏感组和激素耐药组血IL-6分别为118.74±31.18 ng/L和129.62±28.14 ng/L,均较对照组35.13±16.21 ng/L显著升高(P<0.05),激素敏感组和激素耐药组之间比较差异无显著性(P>0.05)。在激素治疗前激素敏感组和激素耐药组尿IL-6分别为14.19±4.87 ng/L和22.54±5.35 ng/L,均较对照组3.62±1.87 ng/L显著升高(P<0.05),而激素耐药组和激素敏感组比较差异有显著性(P<0.05)。激素治疗8周后,激素敏感组血、尿IL-6分别为41.68±18.94 ng/L和5.11±1.31 ng/L,均较治疗前显著降低(P<0.05),与对照组比较差异无显著性,而激素耐药组血、尿IL-6水平分别为115.53±24.65 ng/L,20.74±3.21 ng/L,与治疗前比较差异无显著性(P>0.05)。结论：血、尿IL-6对原发性肾病综合征激素敏感性的判断和预后估计有一定的参考价值。

Serum and urinary interleukin 6 levels in children with primary nephrotic syndrome

OBJECTIVE: Interleukin 6(IL-6) is an autocrine growth factor for mesangial cells.This study aimed to investigate the changes of IL-6 levels in serum and urine of children with primary nephrotic syndrome (PNS) before and after glucocorticoid treatment. METHODS: Thirty-eight children with PNS, including 30 cases with steroid-responsive and 8, steroid-resistant,and 19 age-matched healthy children were enrolled in this study. Serum and urinary IL-6 levels were examined by ELISA before and after prednisone treatment (2 mg/kg daily for 8 weeks). RESULTS: Before prednisone treatment, the serum levels of IL-6 in the steroid-responsive group (118.74±31.18 ng/L) and steroid-resistant group (129.62±28.14 ng/L) were significantly higher than those in the normal controls (35.13±16.21 ng/L)(P<0.05). The IL-6 levels in urine of the steroid-responsive and steroid-resistant groups (14.19±4.87 and 22.54±5.35 ng/L) were also significantly higher than those in the normal controls(3.62±1.87 ng/L) (P<0.05). The IL6 levels of urine were significantly different between the steroid-responsive and steroid-resistant groups.After the treatment with prednisone for 8 weeks, the levels of IL-6 in serum and urine in the steroid-responsive group were significantly reduced to 41.68±18.94 and 5.11±1.31 ng/L respectively, which were not different from those in the normal controls. But the IL-6 levels in serum and urine of the steroid-resistant group did not decrease significantly after prednisone treatment. CONCLUSIONS: The detection of IL-6 levels in serum and urine is useful for the identification of steroid-responsive PNS and for the estimation of the prognosis of PNS.