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益肾降浊冲剂对慢性肾脏病3、4期患者骨代谢的影响及与免疫指标的关系
引用本文:郑京,文丹,翁苓,陈彩凤,郑雪敏,黄璐.益肾降浊冲剂对慢性肾脏病3、4期患者骨代谢的影响及与免疫指标的关系[J].中国中西医结合杂志,2012,32(2):183-187.
作者姓名:郑京  文丹  翁苓  陈彩凤  郑雪敏  黄璐
作者单位:福建中医药大学附属人民医院;福建中医药大学附属人民医院;福建中医药大学附属人民医院;福建中医药大学附属人民医院;福建中医药大学附属人民医院;福建中医药大学附属人民医院
基金项目:陈可冀中西医结合发展基金(No.CKJ2008068);福建省卫生厅基金资助项目(No.WZZSb0911);福建省教委基金资助项目(No.JA08116)
摘    要:目的探讨慢性肾脏病(chronic kidney disease,CKD)3、4期患者治疗前后骨代谢指标--骨钙素(bone gla protein,BGP)、抗酒石酸酸性磷酸酶(tartrate resistant acid phosphatase,TRACP)的变化及与白介素-17(interleukin-17,IL-17)、调节性T细胞(regulatory T cells,Treg)的关系,及益肾降浊冲剂能否影响骨代谢。方法 53例CKD3、4期患者,采用随机数字表法分为治疗组(益肾降浊冲剂)和对照组,以流式细胞仪用三色荧光标记法检测外周血中Treg(CD4+CD25+CD127lo)水平及双抗体夹心酶联免疫吸附(ELISA)法测定外周血中BGP、TRACP、IL-17水平。采用贝克曼库尔特血细胞分析仪查血红蛋白(Hb)含量;由反相高效液相色谱测定方法测定尿肌酐;钙(Ca)、磷(P)、尿素氮(BUN)、血肌酐(SCr)、血浆白蛋白(ALB)由Beckman-C800全自动生化分析仪测定;根据血钙、磷浓度计算钙磷乘积(Ca×P);根据血、尿Cr浓度和24h尿量计算内生肌酐清除率(CCr)。结果两组治疗前Treg无明显变化(P>0.05)。与本组治疗前比较,两组治疗后CD4+、TRACP及对照组IL-17水平差异均有统计学意义(P<0.01,P<0.05)。但与健康组比较,两组各项指标(除CD4+外)差异均有统计学意义(P<0.01)。与对照组治疗后比较,治疗组各项指标差异均无统计学意义(P>0.05)。与本组治疗前比较,两组治疗后Hb、ALB及CCr均上升(P<0.05,P<0.01),SCr降低(P<0.01);与对照组治疗后比较,治疗组SCr降低更明显(P<0.05),CCr升高更显著(P<0.05)。两组治疗前、后IL-17、TRACP、BGP、Treg水平之间均无相关性。结论益肾降浊冲剂能改善CKD3、4期患者肾功能、延缓微炎症的进展,不能提高CD4+CD25+CD127lo水平,对骨代谢无影响;CKD3、4期患者CD4+细胞的分化是向Th17转化,其免疫状态处于一种免疫无能和免疫系统不断被激活的状态;CKD3、4期患者体内炎症因子在诱导破骨细胞活化中起重要作用。

关 键 词:慢性肾脏病  调节性T细胞  白细胞介素-17  抗酒石酸酸性磷酸酶  骨钙素

Effects of Yishen Jiangzhuo Granule on the Bone Metabolism of Patients with Stage 3-4 Chronic Kidney Disease and Its Correlation with the Immune Indices
Authors:ZHENG Jing  WEN Dan  WENG Ling  Chen Chai Feng  Zhen Xue Ming and Huang Lu
Institution:ZHENG Jing,WEN Dan,WENG Ling,et al The People′s Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou(350004)
Abstract:Objective To explore the changes of bone gla protein(BGP) and tartrate resistant acid phosphatase(TRACP) in patients with stage 3-4 chronic kidney disease(CKD) before and after treatment,to study their correlation with interleukin-17(IL-17) and regulatory T cells(Treg),and the effects of Yishen Jiangzhuo Granule(YJG) on the bone metabolism.Methods Fifty-three patients with stage 3-4 CKD were randomly assigned to the treatment group and the control group using random digit table.The following parameters in blood were detected:Treg(CD+4CD25+CD127lo) using trichrism fluorescent labeling by flow cytometry;levels of TRACP,BGP,and IL-17 by double antibody sandwich ELISA.The hemoglobin(HGB) content was detected using Beckman-Coulter hemoanalysis.The urinary contents of creatinine(UCr) were determined using reversed HPLC.The blood contents of calcium(Ca),phosphate(P),blood urea nitrogen(BUN),serum creatinine(SCr),and plasma albumin(ALB) were determined using automatic biochemical analyzer.Then the calcium-phosphate(Ca×P) product was calculated on the basis of blood contents of Ca and P.The clearance rate of endogenous creatinine(CCr) was calculated on the basis of blood BUN and SCr contents.Results(1) There was no obvious change in CD+4CD25+CD127lo in the two groups before and after treatment(P>0.05).Compared with before treatment in the same group,there were statistical difference in the levels of CD4+ and TRACP in the two groups,as well as the IL-17 level in the control group(P<0.01,P<0.05).But compared with the healthy group,statistical difference was shown in each index(except CD+4)(P<0.01).Compared with the control group after treatment,there was no statistical difference in each index of the treatment group after treatment(P>0.05).Compared with before treatment in the same group,the levels of Hb,ALB,and CCr increased(P<0.05,P<0.01),and the SCr level decreased in the two groups after treatment(P<0.05).Compared with the control group after treatment,the SCr level decreased and the CCr level increased more obviously in the treatment group(P<0.05).There was no correlation among the levels of IL-17,TRACP,BGP,and Treg between before and after treatment in the two groups.Conclusions YJG could improve the kidney function and delay the progression of micro-inflammation of stage 3-4 CKD patients.It could not improve the level of CD+4CD25+CD127lo.It also showed no effects on bone metabolism.The CD+4T cells were differentiated to Th17 cells in stage 3-4 CKD patients.Their immunity was in a state of anergy but continually activated.The inflammatory factors in patients with stage 3-4 CKD play important roles in inducing the activation of osteoclasts.
Keywords:chronic kidney disease  regulatory T cell  interleukin-17  tartrate resistant acid phosphatase  osteocalcin
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