尿毒症维持性血液透析近期胸腺输出功能变化研究  

Measurement of recent thymic output function in uremia patients who underwent maintenance hemodialysis

作　　者：李永新[1] 尹青松 汪小娇 李倩玉 魏旭东 

机构地区：[1]郑州市第一人民医院肾内科,河南郑州450008 [2]郑州大学附属肿瘤医院血液科,河南郑州450008

出　　处：《中国实用内科杂志》2012年第10期775-778,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81000921)

摘　　要：目的评估尿毒症维持性血液透析(MHD)患者近期胸腺输出nave T细胞的情况。方法对郑州大学附属肿瘤医院2010年10月至2011年10月收治的15例MHD患者利用实时定量PCR(TaqMan)方法检测其透析前后外周血单个核细胞中T细胞受体删除DNA环(TRECs)的含量,并根据外周血中CD3阳性率计算CD3+T细胞中TRECs水平。以10例年龄相匹配的正常人外周血作为对照。结果与正常人外周血中TRECs拷贝数相比,15例MHD者首次透析前的TRECs均显著低下,分别为(0.48±0.39)拷贝/1000 PBMCs和(1.03±0.57)拷贝/1000CD3+T细胞(P值分别为0.0014和0.0067)。而透析2～6个月后外周血中的TRECs值差异较大,平均为(0.41±0.36)拷贝/1000 PBMCs和(1.33±1.46)拷贝/1000 CD3+T细胞(P值分别为0.0008和0.019),仍明显低于正常水平,与首次透析前的水平相比,差异无统计学意义。结论 MHD患者首次透析前及透析2～6个月后胸腺近期输出nave T细胞功能均明显低下,胸腺近期输出功能低下是导致细胞免疫功能缺陷的根本原因之一。Objective To determine the recent thymic output of naive T ceils in patients with uremia who underwent maintenance hemodialysis （MHD）. Methods Fifteen consecutive patients with uremia were recruited from Affiliated Oncology Hospital of Zhengzhou University between October 2010 and October 2011 and were subjected to detection of T cell receptor excision DNA circles （TRECs） in peripheral blood mononuelear ceils （PBMCs） prior to and after MHD via real-time polymerase chain reaction （TaqMan）. And the level of TRECs was calculated based on the positive rate of CD3^＋T cells in peripheral blood. The peripheral blood drawn from 10 age-matched healthy individuals served as normal control. Results Pri- or to initial dialysis, 15 patients who underwent MHD were found to have considerably lower level of TREC [ （0.48 ± 0. 39） copies/1000 PBMCs and （ 1.03 ± 0. 57 ） copies/1000 CD3 ^＋ T cells ; P =0 . 0014 and 0. 0067, respectively ] as compared with normal controls. Higher between-subject variation in peripheral blood TREC [ （0.41 ± 0. 36）copies/1000 PBMCs and （ 1.33 ±1.46）copies/1000 C D3 ^＋T cells;P = 0. 0008 and 0. 019,respectively] was shown at months 2 to 6 after MHD yet these levels remained remarkably lower than that of normal controls. The difference with pre-treatment level did not yield statistical difference （ P 〉 0. 05 ）. Conclusion Patients who underwent MHD are featured by markedly impaired recent thymic output naive T cell immunity prior to initial dialysis and at months 2 to 6 thereafter. Low recent thymie output function may contribute to cellular immunity defect.

关 键 词：维持性血液透析 胸腺近期输出功能 免疫功能 T细胞受体重排删除环 

分 类 号：R459.1[医药卫生—治疗学]