Correlation between the expression levels of glucocorticoid receptors in peripheral blood and tissues and the therapeutic effect of prednisone in patients with nephrotic syndrome

Objective To investigate the correlation between glucocorticoid receptor (GR) expression levels in peripheral blood and tissue and the therapeutic efficacy of prednisone in patients with nephrotic syndrome (NS).Methods A total of 138 NS patients were selected from the patients that admitted to the Shapingba District Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to September 2020. All patients received prednisone treatment and were divided into effective and ineffective groups based on treatment outcomes. General information and laboratory examination data were collected for both groups. A multifactor logistic regression model was used to establish the relevant factors affecting the therapeutic efficacy of prednisone in NS patients. A restricted cubic spline plot was employed to depict the correlation between GR expression levels in peripheral blood and tissue and the therapeutic efficacy of prednisone in NS patients.Results At the end of follow-up, a total of 133 cases were included (5 cases were lost to follow-up), among which 43 cases were ineffective (32.33%) and 90 cases were effective (67.67%). The ineffective group exhibited lower levels of urinary γ-GT, glomerular GR, and peripheral blood GR expression compared to the effective group, while 24-hour urine protein levels were higher in the ineffective group (P<0.05). Multifactor logistic regression revealed that urinary protein (OR=5.394,95%CI 2.120~13.720) was a risk factor for the therapeutic efficacy of prednisone in NS patients, while urinary γ-GT (OR=0.950, 95%CI 0.907~0.995),glomerular GR (OR=0.570, 95%CI 0.392~0.827) and peripheral blood GR (OR=0.995, 95% CI 0.992~0.997) were protective factors (all P<0.05). The restricted cubic spline plot indicated a significant nonlinear relationship between peripheral blood and tissue GR levels and the therapeutic efficacy of prednisone in NS patients (χ²= 31.760, P<0.001; χ²= 20.770,P<0.001).Conclusions There is a correlation between the expression levels of peripheral blood and tissue GR and the therapeutic efficacy of prednisone in NS patients.