A STUDY OF THE RELATION BETWEEN POLYMORPHISM OF STEROID RECEPTOR AND CLINICAL COURSE IN IgA NEPHROPATHY IN CHILDREN

[1]。目的：探讨雌激素受体(ER)和血管紧张素转换酶(ACE)基因多态性对IgA肾病临床及组织学预后的影响。材料和方法：74例IgA肾病患儿接受强的松龙方案治疗2年，治疗后行连续肾活检。提取外周血单个核细胞DNA，用聚合酶链式反应(PCR)扩增ER和ACE基因，用RFLP方法检测其多态性。分析儿童IgA肾病各临床参数与这些基因多态性的关系。结果：(1)ER基因多态性中，PP 9例(18.3%)，PP 35例(71.5%)，PP 5例(10.2%)。(2)ACE基因多态性中，II型14例(25.9%)，ID型28例(51.9%)，DD型12例(22.2%)。(3)PP患儿治疗后慢性化指数显著降低，而PP和PP患儿治疗前后活动指数无明显变化。(4)ID、DD患儿治疗前活动指数显著高于II患儿，治疗后虽无统计学意义，但治疗后ID、DD患儿慢性化指数较高。无一例II患者，治疗后排尿情况恶化。另一方面，在一些ID和DD患者中，病情恶化。

[1]. Purpose :In this study, we investigated whether the polymorphism of estrogen receptor (ER) and ACE gene had any effect on the clinical or histological prognosis of IgA nephropathy.[2]. Material and Method :74 children with IgA nephropathy, who were treated with the protocol including prednisolone for 2 years, and serial renal biopsy could be performed after treatment, were included in this study. DNA was extracted from peripheral mononuclear cells, genes of ER and ACE were amplified by PCR and polymorphism of them were examined with RFLP. The relation of clinical parameters of children with IgA nephropathy and polymorphisms of these genes were analyzed.[3]. Results :(1) In the polymorphism of ER gene, 9 were PP (18.3%), 35 were Pp (71.5%) and 5 were pp (10.2%). 25 patients cold not be studied or their genes could not be amplified.(2) In the polymorphism of ACE gene, 14 were II (25.9%), 28 were ID (51.9%) and 12 were DD (22.2%). 20 patients cold not be studied or their genes could not be amplified.(3) Chronicity index was significantly reduced by treatment in the children with PP, but not changed in the children with Pp and pp.(4) Before treatment, activity index was significantly high in the children with ID and DD, compared with the children with II. Although statistically not significant, chronicity index after treatment was higher in the children with ID and DD. There was no patient with II, whose urinalysis became worse after treatment. On the other hand, it worsened in some patients with ID and DD.