激素抵抗型肾病综合征患者T淋巴细胞亚群及调节性T细胞的变化及意义  

Changes and clinical significance of T lymphocyte subsets and regulatory T cells in peripheral blood of patients with steroid-resistant nephrotic syndrome

作　　者：叶琨[1] 王浩宇[1] 龚智峰[1] 韦俏宇[1] 蓝娇[1] 

机构地区：[1]广西壮族自治区人民医院肾内科,南宁530021

出　　处：《中国临床新医学》2014年第2期99-103,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广西自然科学基金资助项目(编号:桂科自0991214)

摘　　要：目的探讨激素抵抗型原发性肾病综合征(SRNS)患者T细胞亚群(CD3+CD4+、CD3+CD8+、CD4/CD8)及Treg(CD4+CD25+highCD127low)的动态变化趋势及临床意义。方法选取初治原发性肾病综合征(PNS)患者65例,标准剂量泼尼松治疗(1 mg·kg-1·d-1)8周后,根据病情缓解与否筛选出SRNS组患者24例。正常对照组30例。患者于治疗前(W0)、治疗4周(W4)、治疗8周(W8)采用流式细胞术检测T细胞亚群及Treg。结果①SRNS组激素治疗8周后,除Alb较治疗前有所升高外(P<0.05),尿蛋白定量、血肌酐(Scr)、尿素氮(BUN)、胆固醇(Cho)、甘油三酯(TG)治疗前后差异无统计学意义(P>0.05)。②SRNS组患者W0与正常对照组比较,CD4%、CD4/CD8升高,而Treg/CD4下降(P<0.05)。SRNS组治疗8周后与治疗前比较,CD4%、CD8%、CD4/CD8、Treg、Treg/CD4差异均无统计学意义(P>0.05)。结论 SRNS患者存在T细胞数量异常,T细胞亚群及Treg/CD4比值失调情况。糖皮质激素治疗8周未能有效改善其临床表现及免疫异常状态。Objective To investigate the change trend of T lymphocyte subsets （ CD3 ＋CD4 ＋,CD3 ＋CD8 ＋, CD4/CD8） and regulatory T cells（Treg,CD4 ＋CD25 ＋highCD127low） in adult patients with steroid-resistant nephrotic syndrome（SRNS） and its clinical significance.Methods Twenty-four SRNS patients enrolled in SRNS group were chosen from 65 inpatients with primary nephrotic syndrome （PNS） first treated with prednisone （1 mg·183; kg-1 ·183; d-1 ） for eight weeks , according to the state of clinical remission of PNS .Thirty normal persons were served as healthy con-trol group.T lymphocyte subsets and Treg were detected by flow cytometry before treatment （W0 group）, after 4-week treatment（W4 group） and after 8-week treatment（W8 group）.Results ①Compared with W0 group, plasma albu-min（ Alb） increased significantly （ P〈0.05 ） , while urinary protein , serum creatinine （ Scr ） , blood urea nitrogen （BUN）, cholesterol（Cho）and triglycerides（TG） had no significant differences in W8 group（P〈0.05）.②Com-pared with control group , CD4%and CD4/CD8 ratio increased significantly , while Treg/CD4 ratio decreased signifi-cantly in W0 group（P〈0.05）.Compared with W0 group,CD4%,CD8%,CD4/CD8,Treg and Treg/CD4 had no sig-nificant differences in W8 group（P〈0.05）.Conclusion There are changes of T cell populations , T lymphocyte subsets and Treg/CD4 ratio imbalance in SRNS adult patients .The clinical manifestation and the disorder immune state even sustained after 8-week treatment of glucocorticoid .

关 键 词：肾病综合征 调节性T淋巴细胞 T淋巴细胞亚群 免疫 糖皮质激素 REGULATORY T LYMPHOCYTES ( Treg) 

分 类 号：R692[医药卫生—泌尿科学]