性激素与CD4~+CD25~+调节性T细胞的相关性及在肾移植免疫耐受中的作用研究

目的:为明确肾移植术后因供肾、受肾性别差异而排斥反应发生率不同,移植肾存活率不同而进行性激素水平的研究,明确性激素与CD4~+CD25~+调节性T细胞(CD4~+CD25~+Treg)的相关性及在肾移植免疫耐受中的作用。方法:选取正常对照组、肾移植组患者各20例,用ELISA法测定外周血性激素睾酮(T)、雌二醇(E_2)水平,用流式细胞术(FCM)测定CD4~+CD25~+Treg占CD~+T细胞比值。结果:肾移植术后女性E_2水平逐渐由高变低,男性T水平逐渐由低变高,CD~+CD25~+Treg水平也随时间相关性而逐渐升高,以单因素方差分析发现:E_2水平平稳期与正常对照组比较无显著差异(P0.05);T平稳期与正常对照组比较无显著差异(P0.05);肾移植男性受者早期2周内调节T细胞水平与正常值比较有明显差异(P0.05),门诊随访肾移植达2年患者其调节t细胞与正常对照组无明显差异(P0.05)。T与CD4~+CD25~+Treg术后均依时间相关性而逐渐上升,以直线相关性分析发现两者有明显相关性(P0.05)。结论:肾移植术后随着下丘脑-垂体-性腺轴的恢复,患者性激素水平及CD4~+CD25~+Treg水平均逐渐恢复正常。排除体重、年龄、透析时间、HLA配型、缺血时间、术后糖皮质激素、免疫抑制剂治疗方式等因素的影响,T与CD4~+CD25~+Treg有明显相关性,男性在肾移植术后不仅可以通过雄激素直接抑制效应T细胞发挥主要免疫抑制作用,还可以通过增加CD4~+CD25~+Treg水平来发挥次要免疫抑制作用。

The Relationship Between Sex Hormones And Regulation T Cells and its Role in Immune Tolerance After Renal Transplantation

Objective：Investigate the relevance of sex hormones and the CD4^＋CD25^＋ Treg, and the their roles in immune tolerance for renal transplantation. Methods：20 patients of normal control group and 20 of Renal trans- plant patients were selected. ELISA method was employed to detect the sex hormones levels in peripheral blood, the FCM accounting for the CD4^＋CD25^＋ Treg ceils. Results：Compared with the control group, the levels of testosterone gradually increased, and the Estradiol levels gradually decreased as the time correlation after renal transplantation , the level of CD4^＋CD25^＋ Treg T cells also increased gradually as the time went on. Exclude the im- pact of weight, age, dialysis time, HLA matching and other factors ,the sex hormone testosteronel and the level of CD4^＋CD25^＋ Treg showed the significant correlation by the linear correlation analysisP〈0.05. Conclusions： After renal transplantation the males not only can inhibit T Lymphocytes directly to play the major immunosuppression, but also can increase the level o.f regulation T cells to play the secondary immunosuppression.