肾病综合征患儿血清细胞因子水平及T细胞亚群变化的临床意义  

Clinical Significance of Serum Cytokines-level and T Cell Subsets in Children with Primary Nephrotic Syndrome

作　　者：童科珍 毛建华[2] 傅海东[2] 沈辉君[2] 刘爱民[2] 

机构地区：[1]宁波市鄞州人民医院儿科,浙江宁波315040 [2]浙江大学医学院附属儿童医院肾内科,杭州310006

出　　处：《中华临床免疫和变态反应杂志》2016年第4期351-356,共6页Chinese Journal of Allergy & Clinical Immunology

基　　金：国家自然科学基金(81270792,81470939,81170664);十二五科技支撑计划-儿童遗传性肾脏疾病的分子分型体系的建立及示范推广(2012BAI03B02);浙江省自然基金(LH14H050002);浙江省医药卫生科技创新项目(WKJ2010-2-014,2012KYA119,2014KYA123)

摘　　要：目的探讨原发性肾病综合征患儿Th1/Th2相关细胞因子及T细胞亚群的变化和差异及对临床的指导作用。方法采集2011年10月至2015年7月在浙江大学附属儿童医院肾内科住院的184例肾病综合征患儿资料。其中67例非频复发激素敏感型肾病综合征(steroid sensitive nephrotic syndrome,SSNS)患儿(非频复发组),67例为激素敏感但频复发肾病综合征(SSNS with frequent relapses,FRNS)患儿(频复发组),50例为激素耐药型肾病综合征(steroid-resistant nephrotic syndrome,SRNS)患儿(激素耐药组),另选择60例健康儿童(对照组),检测其血清白细胞介素(interleukin,IL)-2、γ干扰素(interferonγ,IFN-γ)、IL-6、IL-10和CD3+、CD4+、CD8+T淋巴细胞及CD4/CD8水平,分析其变化与临床相关性。结果 (1)与对照组或非频复发组相比较,频复发组及激素耐药组患儿IL-10血浆水平较高[分别为(2.81±0.81)和(3.68±1.37)ng/L vs.(7.64±5.99)和(6.40±6.45)ng/L],差异有统计学意义(P<0.001)。频复发组IL-10≥5 ng/L的患儿例数显著多于非频复发组(40/67 vs.9/67),差异有统计学意义(P<0.001)。IL-10的受试者工作特征(receiver operator characteristic,ROC)曲线显示IL-10≥5 ng/L对SSNS患儿的频复发具有预测价值(曲线下面积为0.736,敏感度59.7%,特异度85.1%)。(2)血浆IL-6浓度以激素耐药组为最高,高于激素敏感的其他两组,差异有统计学意义(P<0.05)。(3)与对照组相比较各病例组血浆IL-2及IFN-γ浓度均较低,差异有统计学意义(P<0.05)。(4)非频复发组的CD4+T淋巴细胞值高于频复发组、激素耐药组和对照组,差异有统计学意义(P<0.05)。结论血浆IL-10浓度升高提示肾病综合征患儿可能更易出现蛋白尿持续/反复。IL-10≥5 ng/L对SSNS患儿出现病情频反复具有预测价值。Th1/Th2型细胞因子及T细胞亚群变化与原发性肾病综合征患儿免疫功能紊乱相关,在原发性肾病综合征发病机制中起到一定作用。Objective The association between the expression profile of Th1/Th2 cytokines ＆ T lymphocyte subtypes and clinical guidance in children with primary nephrotic syndrome （PNS） was evaluated in pres- ent study. Methods From October 2011 to July 2015, 184 children with PNS in the department of nephrology of Children＇s Hospital of Zhejiang University School of Medicine were recruited. The serumconcentrations of IL-2, IL-6, IL- 10, IFN-γ and T lymphocyte subtypes such as CD3＋, CD4 ＋ , CD8＋ lymphocytes and CD4/CD8 ratio were evaluated in 67 steroid sensitive nephrotic syndrome （SSNS） chil- dren without frequent relapses, 67 SSNS with frequent relapses （FRNS）, 50 patients with steroid-resist- ant nephrotic syndrome （SRNS） and 60 healthy children, respectively. Results （1） Compared with the control group and the NFR-SSNS group, the plasma levels of IL-10 in the FR-SSNS group and the SRNS group were higher [ （2. 81 ±0. 81） ng/L, （3. 68 ±1.37） ng/L vs. （7. 64±5. 99） ng/L, （6. 40 ±6. 45） ng/L], the difference was significant, P 〈 0. 001. The case number with IL-10 ≥5 ng/L in FRNS was more than the cases from SSNS without frequent relapses （40/67 vs. 9/67）, P 〈0. 001. The ROC curve of IL- 10 showed that IL- 10 ≥5 ng/L had predictive value in FRNS patients （ AUC = 0. 736, sensitivity 59.7%, specificity 85.1% ）. （2） Plasma IL-6 level was highest in the SRNS group, higher than the other two SSNS groups, P 〈 0. 05. （3） Compared with the control group, the plasma IL-2 and IFN-γ levels were significantly lower in case groups, P 〈 0. 05. （ 4 ） The value of CD4 ＋ T lymphocytes in NFR-SSNS was higher than the other three groups respectively, the difference was significant, P 〈 0. 05. Conclusions The high plasma levels of IL-10 can predict the onset of proteinuria continuance/recur- rence in children with PNS. IL-10 ≥5 ng/L might play an important role in predicting frequent relapse in children with SSNS. The results from present study implies tha

关 键 词：肾病综合征 儿童 T淋巴细胞 白细胞介素10 

分 类 号：R726.9[医药卫生—儿科]