激素敏感型肾病综合征患儿血清、外周血单个核细胞白细胞介素-18表达的意义

目的探讨小儿激素敏感型肾病综合征(SSNS)与白细胞介素-18(IL-18)的关系及地塞米松(DEX)对外周血单个核细胞(PBMC)体外培养表达IL-18的抑制作用。方法单纯型SSNS23例。采用ELISA测定患儿治疗前后血清、尿液IL-18水平和PBMC体外培养上清液中IL-18表达。对照组为相应年龄健康儿童15例;另18例年龄相似的呼吸道感染病例作为感染对照组。结果治疗前后血清、尿液IL-18水平有显著性差异(t=15.072,16.149Pa<0.001)。治疗前PBMC在植物血凝素(PHA)刺激下体外培养上清液中IL-18表达明显高于治疗后和正常对照组(t=6.526,5.585Pa<0.001)。培养液中加入DEX后PBMC表达IL-18水平明显低于未加DEX组(t=4.217P<0.001)。血、尿IL-18与24h尿蛋白定量呈显著正相关(r=0.768,0.638P<0.05)。血清IL-18与PBMC体外培养上清液中IL-18水平呈正相关(r=0.574P<0.05)。结论SSNS的发病与IL-18密切相关;PBMC高表达IL-18可能是其血清IL-18增高原因之一。

Significance of Changes of Interleukin-18 Expression Levels of Serum and Peripheral Blood Mononuclear Cells in Children with Steroid-Sensitive Nephrotic Syndrome

Objective To investigate the relationship between the steroid-sensitive nephrotic syndrome(SSNS) and interleukin-18(IL-18) and to approach the inhibitive role of dexamethasone(DEX) on expression of IL-18 of peripheral blood mononuclear cells(PBMC) in children with SSNS in vitro.Methods IL-18 levels of serum, urine and supernatants of PBMC cultured in vitro were measured by enzyme linked immunosorbent assay(ELISA) in 23 children with SSNS who were either before or after treatment. Fifteen age-matched healthy children served as normal control group, and another 18 children with respiratory infections as infectious control group.Results There were signi-ficant differences of IL-18 in serum and urine before and after treatment in children with SSNS (t=15.072,16.149 Pa<0.001).IL-18 levels in supernatants of PBMC plus phytohemagglutinin(PHA) without DEX cultured in vitro before treatment were much higher than those after treatment and of normal control group and of PBMC plus PHA without DEX (t=6.526,5.585,4.217 Pa<0.001). There were positive correlation between IL-18 levels of serum and protein in urine of 24 hours(r=0.768 P<0.05), between IL-18 level of urine and protein in urine of 24 hours(r=0.638 P<0.05), and between IL-18 levels in serum and supernatants of PBMC cultured in vitro(r=0.574 P<0.05).Conclusions The levels of IL-18 is increased in SSNS children and this increase is related to the activity of this disease. The data also indicates that increased serum IL-18 levels is partially related to the expression of IL-18 of PBMC.