原发性肾病综合征患者肾组织、血和尿TNF—α变化及其意义

目的　探讨TNF α在原发性肾病综合征 (PNS)发病中所起的作用。方法　检测 40例PNS患者和 10名正常人血、尿、肾组织TNF α含量。 40例PNS患者接受糖皮质激素常规治疗。分别于治疗后 1、2、4、8周复查血、尿TNF α水平 ,并与正常人血、尿TNF α水平进行比较。结果　40例PNS患者肾组织局部、血、尿TNF α均较正常对照组明显增高 (P <0 .0 1)。激素治疗后显效31例 ,无效 9例 ,显效率为 77.5 %。显效者血、尿TNF α早期即开始下降 ,而激素治疗无效者血、尿TNF α无明显变化。血、尿TNF α与血尿素氮 (BUN)、血肌酐 (Scr)、2 4h尿蛋白定量 (Pro)明显正相关 ;与内生肌酐清除率 (Ccr)明显负相关。结论　TNF α参与PNS发病及疾病进展 ;激素治疗PNS有效 ,其作用机制可能与其抑制TNF α产生有关 ;血、尿TNF α可作为评价PNS发病及疾病活动性的一个临床指标。

Changes of renal tissue TNF-

Objective　To investigate the role of TNF-α in occurrence of primary nephrotic syndrome(PNS).Methods　The plasma, uria and renal tissue levels of TNF-α were tested in 40 PNS patients and 10 health doners. After treatment with corticosteroids, the plasma and uria levels of TNF-α were checked again and compared with normal control group.Results　The renal tissue, plasma and uria levels of TNF-α in 40 patients elevated obviously as compared the normal controls(P<0.01). After treatment with corticosteroids, 31 cases were treat effectively and their plasma and uria levels of TNF-α decreased rapidly while 9 cases were ineffectivelly and their plasma and uria levels of TNF-α were unchanged (P>0.05). The plasma and urine TNF-α had positive correlation with BUN, Scr, Pro(24 hour's urinary protein volume) and negative correlation with Ccr.Conclusion　TNF-α participates in with occurrence and development of primary nephrotic syndrome. The effect mechanisms of corticosteroids can treat PNS, being related to inhibition in production of TNF-α. Plasma and uria levels of TNF-α can be served as an clinical index of estimating occurrence and activity of PNS.