原发性肾病综合征患儿CD4＋ CD25＋调节性T细胞和T淋巴细胞亚群的变化及其意义

目的观察原发性肾病综合征（PNS）患儿CD4＋ CD25＋调节性T细胞（CD4＋ CD25＋T reg）和T淋巴细胞亚群的变化,以探讨儿童PNS的发病机制。方法选择初发PNS患儿33例,其中单纯型肾病20例,肾炎型肾病13例,16例健康体检儿童作为对照组。应用流式细胞术（FCM）检测激素治疗前后外周血CD3＋ CD4＋、CD3＋ CD8＋、CD4＋ CD25＋T reg的比例。结果与对照组比较,PNS患儿外周血CD3＋ CD4＋T细胞、CD3＋ CD8＋T细胞比例无明显改变（均P〉0.05）。单纯型肾病组和肾炎型肾病组与对照组相比,CD4＋ CD25＋T reg均显著降低（均P〈0.01）,而单纯型肾病组与肾炎型肾病组之间无明显差异（P〉0.05）;经强的松治疗4周后,单纯型肾病组和肾炎型肾病组激素尿蛋白转阴的患儿（缓解组）CD4＋ CD25＋T reg比例均显著增高（均P〈0.01）,而肾炎型肾病组尿蛋白未转阴的患儿（未缓解组）CD4＋ CD25＋T reg比例无明显改变（P〉0.05）。结论 CD4＋ CD25＋T reg的下降可能参与了肾病综合征的发生,糖皮质激素可通过上调PNS患儿CD4＋ CD25＋T reg的比例而发挥治疗作用。

The Change and Significance of CD4+CD25+T Regulatory Cell and T Lymphocyte Subpopulation in Children with Primary Nephritic Syndrome

Objective To investigate the change and significance of CD4＋ CD25＋ T regulatory（reg） and T lymphocyte subpopulation in the children with PNS.Methods Thirty-three patients with PNS were divided into the simple NS group（20 cases） and nephritis NS group（13 cases）,16 healthy children were taken as the controls.Before and after the treatment with prednisone,FCM was used for to detecting the percentage of CD4＋ CD25＋ T reg and T lymphocyte subpopulation（including CD3＋ CD4＋,CD3＋ CD8＋ T cells）.Results Compared with the controls,the percentage of CD3＋ CD4＋ 、CD3＋ CD8＋ T cells in patients with PNS there was no change（P0.05）,but the percentage of CD4＋ CD25＋ T reg in both the simple NS group and the nephritis NS group was lower than that in the control group.The percentage of CD4＋ CD25＋ T reg in the simple NS group was significantly higher after treatment with prednisone than before（P0.01）,in the nephritis NS group,the same result was found in those patients who got remission 4 weeks after the prednisone therapy,but there was not any significant change in those who did not get remission.Conclusion The decrease of CD4＋ CD25＋ T reg might play a pathological role in the PNS development,and glucocorticoid may have immunotherapeutic effect by up-regulating CD4＋ CD25＋ T reg ratio in PNS.