尿毒症维持性血液透析患者T细胞亚群监测的临床意义探讨

目的观察尿毒症维持性血液透析患者不同透析阶段各T淋巴细胞亚群的分布状况。方法通过流式细胞术(FCM)检测20例尿毒症维持性血液透析患者不同透析阶段外周血中CD3+、CD3+CD4+、CD3+CD8+、CD4+CD25+T细胞亚群的水平,16例正常外周血作为对照。结果透析前患者外周血中CD3+、CD3+CD4+、CD3+CD8+T细胞亚群的比例均明显低于正常对照,透析后各T细胞亚群均较透析前明显上升(P<0.05),达到正常水平,而各透析阶段之间的分布情况未能显示出统计学差异。并且不同透析阶段的CD4/CD8比值均保持平衡状态。不同透析阶段患者CD4+CD25+T细胞均低于正常对照,而透析1年后的CD4+CD25+T细胞比率明显减低(P<0.05)。患者首次透析前体内的低白蛋白、高尿素氮水平与各T细胞亚群低下明显相关。结论尿毒症患者透析前存在严重的T细胞亚群低下,透析后CD3+、CD3+CD4+、CD3+CD8+T细胞水平得到提高,但不能改善CD4+CD25+T细胞的低下。监测患者T细胞亚群的变化,一定程度上反映了患者体内的T细胞免疫功能状态。

Clinical significance the survey of T cell subsets in maintenance hemodialysis patients with uremia

Objective To observe the change of T cell subsets at different stage of hemodialysis in maintenance hemodialysis(MHD) patients with uremia.Methods Twenty patients with MHD and 16 age-matched healthy volunteers were enrolled in the study.The percentages of T cell subsets including CD3+,CD3+CD4+,CD3+CD8+,CD4+CD25+T cell using flow cytometry were detected.Results The percentages of CD3+,CD3+CD4+,CD3+CD8+ T cells first before hemodialysis were lower than that of normal level in the peripheral blood of MHD patients,and the percentages of different T cell subsets increased dramatically after hemodialysis(P<0.05) and arrived at normal level,but the difference was not significant within the different stage of hemodialysis.And CD4/CD8 ratio kept balance through the hemodialysis.The percentage of CD4+CD25+T cells were lower than that of normal level and decreased significantly after hemodialysis 1 year later(P<0.05).There were obvious correlation between the level of both lower albumin and higher BUN and lower percentage of T cell subsets.Conclusions There was obviously low percentage of T cell subsets first before hemodialysis,and the percentages of CD3+,CD3+CD4+,and CD3+CD8+ T cell subsets increased significantly after hemodialysis,but the level of CD4+CD25+T cells did not improve.Monitoring the change of T cell subsets at different stage of hemodialysis in MHD patients with uremia could reflect immune function of T cells to some extent.