| Objective:Nephrotic syndrome can be divided into hormone sensitive nephrotic syndrome(SSNS)and hormone resistant nephrotic syndrome(SRNS)through the sensitivity to the hormone therapy in children.We expect to predict sensitivity to the hormone therapy in children with nephrotic syndrome in gene level through the detection of TaqI vitamin D receptor gene polymorphism in children with nephrotic syndrome.At the same time,we detect bone metabolic markers before and after the treatment of active vitamin D treatment.We expect to predict the risk of osteoporosis in children with nephrotic syndrome and assessment of effect in gene level.Methods:The object of the study is th 70 cases of children with nephrotic syndrome in pediatrics in the first affiliated.ospital of kunming medical university from 2015,May to 2016,November.In the second day early morning,we detect the vitamin D receptor TaqI gene polymorphism and bone metabolic markers with fasting blood.we detect bone metabolic markers with in an interview with empty stomach blood after 2 weeks treatment of calcitriol(0.25 ug,qd)once again.Nephrotic syndrome can be divided into hormone sensitive nephrotic syndrome of 42 cases and steroid resistant nephrotic syndrome of 28 cases according to the urine protein regression after 4 weeks plenty of glucocorticoid therapy(prednisone 2 mg/kg,the maximum(?)60 mg)in nephrotic syndrome.Vitamin D receptor TaqI gene polymorphism in accordance with Hardy Weinberg equilibrium between hormone sensitive nephrotic syndrome and hormone resistant nephrotic syndrome.We expect to predict sensitivity to the hormone therapy in children with nephrotic syndrome in gene level through the distribution of vitamin D receptor TaqI genotype between hormone sensitive nephrotic syndrome and hormone resistant nephrotic syndrome.The 70 cases of children with nephrotic syndrome were divided into three groups(TT,Tt,tt)according to different genotypes,then we compared the change of bone metabolic markers in different genotypes.We compared the change of bone metabolic markers in the three genotypes after 2 weeks of calcitriol treatment.Results:1.Vitamin D receptor gene TaqI polymorphisms and steroid responsiveness in childhood nephrotic syndrome:A total of 70 NS(42 steroid sensitive[SS]and 28 steroid resistant[SR])patients with a mean age of 9.14±3.80 years were studied.The TT genotype of VDR-Taql polymorphism was detected in 57.1%of the SS patients compared to 57.1%of SR patients(P=1.000).The Tt genotype was detected in 26.2%of SS patients compared to 25.0%of SR patients(P=0.911).The tt genotype was detected in 16.7%of SS patients compared to 17.9%of SR patients(P=0.897).The T-allele frequency was 70.2%in SS patients compared to 69.6%of SR patients.The t-allele frequency was29.8%in SS patients compared to 30.4%of SR patients,(P=0.096).Summarizing,no significant difference was detected in terms of VDR-Apal polymorphism in SS patients compared to SR patients for all the three genotypes(P=1.000,P=0.911.and P=0.897).No significant difference was found in any of the allele frequencies between SS and SR(P=0.096).2.The bone metabolic markers between different genotypes of vitamin D receptor TaqI gene Polymorphism in children without calcitriol treatment:The F value of calcitonin(CT).25(OH)D3(VIT-D).parathyroid hormone(PTH).Calcium(Ca).phosphorus(P).alkaline phosphatase(ALP)in the three genotypes(TT TT TT)of vitamin D receptor TaqI gene polymorphism are:0.574,2.973,1.947,2.566,0.423,0.242,P>0.05.The F value of magnesium(Mg)is 9.278,P<0.001.Before the treatment of calcitriol,the distribution of calcitonin,25(OH)D3,parathyroid hormone,calcium,phosphorus and alkaline phosphatase has no meanings in the vitamin D receptor gene TaqI three genotypes(TT Tt tt).Magnesium in the vitamin D receptor gene TaqI three genotypes(TT TT TT)distribution is meaningful.The distribution of magnesium in TT genotype and Tt genotype has no statistical significance.The distribution of magnesium in TT genotype and tt genotype has statistical significance.The distribution of magnesium in Tt genotype and tt genotype has statistical significance.3.The bone metabolic markers of vitamin D receptor gene TaqI three genotype between calcitriol treatment and no calcitriol treatment:ln children with TT genotype,after calcitriol treatment 2 weeks,the t value of calcitonin.25(OH)D3.parathyroid hormone.magnesium.phosphorus.alkaline phosphatase are:0.796,0.290,0.295,0.574.0.830,0.933,P>0.05 compared with treatment before.The t value of Ca is 4.301,P<0.001.In the TT genotype of children,the distribution of calcitonin,25(OH)D3,parathyroid hormone,magnesium,phosphorus,alkaline phosphatase has no statistical significance before and after the treatment,calcium statistically significant.In children with Tt genotype,the t value of calcitonin.25(OH)D3.parathyroid hormone.calcium.magnesium.phosphorus.alkaline phosphatase are:0.722,1.298,1.391,1.511,1.671,1.045,0.368.P>0.05.In the Tt genotype of children,the distribution of calcitonin.25(OH)D3.parathyroid hormone,calcium.magnesium.phosphorus,alkaline phosphatase has no statistical significance before and after the treatment.In children with tt genotype,the t value of calcitonin.25(OH)D3.parathyroid hormone.magnesium.phosphorus.alkaline phosphatase are:1.168,1.755,1.787.2.344,1.777.1.808.P>0.05;the t value of Ca is 2.458,the P<0.005.In the tt genotype of children,the distribution of calcitonin,25(OH)D3,parathyroid hormone,magnesium,phosphorus,alkaline phosphatase has no statistical significance before and after the treatment,calcium statistically significant.Conclusion:1.Our data do not support the use of VDR-Taq? gene polymorphisms as genetic markers of SRNS nor do they predict steroid responsiveness in children with the disease.2.In children with nephrotic syndrome,vitamin D receptor Taql gene polymorphism can not assess the risk of osteoporosis?3.In children with nephrotic syndrome,vitamin D receptor Taql gene polymorphism can Predict the reactivity of calcitriol therapy,TT genotype and tt genotype have better reactivity of calcitriol therapy.Serum calcium was significantly elevated after 2 weeks treatment of calcitriol.The risk for osteoporosis is significantly reduced. |
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