激素敏感型原发性肾病综合征患者外周血T淋巴细胞亚群及调节性T淋巴细胞的变化及意义

目的通过测定激素敏感型原发性肾病综合征（SSNS）患者外周血T细胞亚群（CD3＋CD4＋、CD3＋CD8＋、CD4/CD8）及调节性T淋巴细胞（Treg,CD4＋CD25＋highCD127low）,探讨其在病情不同阶段的动态变化趋势及临床意义。方法选取在该科初治的原发性肾病综合征（PNS）患者,经标准剂量激素治疗（1mg·kg-1·d-1）8周后,根据病情缓解与否筛选出SSNS组患者35例,正常对照组30例。患者分别于治疗前（W0）、治疗4周（W4）、治疗8周（W8）常规进行实验室检查包括尿蛋白定量、血白蛋白（Alb）、血肌酐（Scr）、胆固醇（Cho）、甘油三酯（TG）等],采用流式细胞术检测T淋巴细胞亚群及Treg。结果 （1）实验室指标比较：SSNS组患者W4、W8分别与W0比较,尿蛋白、Cho、TG及Scr均显著下降（P〈0.05）,Alb显著升高（P〈0.05）。W8与W4比较,Alb升高（P〈0.05）,其余指标两组间比较差异无统计学意义（P〉0.05）。（2）SSNS组与正常对照组比较：SSNS组患者W0与正常对照组比较,CD4%、CD4/CD8有升高趋势,而Treg及Treg/CD4轻微下降,但差异均无统计学意义（P〉0.05）。W4与正常对照组比较,CD4%、CD4/CD8比值升高（P〈0.05）,Treg/CD4比值降低（P〈0.05）。W8与正常对照组比较,CD4%、CD8%、CD4/CD8比值、Treg、Treg/CD4比值的差异均无统计学意义（P〉0.05）。（3）SSNS组治疗期间动态变化：SSNS组W8与W4比较,CD4%下降,CD8%升高,CD4/CD8比值下降,Treg及Treg/CD4均明显升高（P〈0.05）,以上指标与正常对照组比较差异无统计学意义（P〉0.05）。结论 SSNS患者存在T淋巴细胞数量异常,T淋巴细胞亚群及Treg/CD4比值失调,且此异常的免疫状态当糖皮质激素治疗4周时仍然持续存在,治疗8周达临床完全缓解后得以改善。Treg可能在SSNS患者的病情缓解中发挥作用。

Changes and clinical significance of T lymphocyte subsets and regulatory T cells in peripheral blood of patients with steroid-sensitive nephrotic syndrome

Objective To detect changes of T lymphocyte subsets（CD3 ＋ CD4 ＋,CD3 ＋ CD8 ＋,CD4/CD8） and regulatory T cells（Treg,CD4 ＋ CD25 ＋ high CD127 low） in adult patients with steroid-sensitive nephrotic syndrome（SSNS）,and investigate dynamic change trend and clinical significance in different stages of primary nephrotic syndrome（PNS）.Methods Thirty-five SSNS patients enrolled in SSNS group were inpatients in our department first treated with prednisone（1 mg.kg-1.d-1） for eight weeks,according to clinical remission of PNS.Thirty normal persons were served as healthy control group.Regular laboratory examinations were detected before treatment（W0 group）,4-week treatment（W4 group） and 8-week treatment（W8 group）,such as proteinuria,blood albumin（Alb）,serum creatinine（Scr）,cholesterol（Cho） and triglycerides（TG）.T lymphocyte subsets and Treg were detected by flow cytometry.Results（1） Compared with W0 group,proteinuria,Cho,TG and Scr decreased significantly（P ＆lt; 0.05）,while Alb increased significantly（P ＆lt; 0.05） in W4 group and W8 group.Alb in W8 group washigher than that of W4 group（P ＆lt; 0.05）.There were no significant differences in above other indexes between W4 group and W8 group（P ＆gt; 0.05）.（2） Compared with control group,CD4% and CD4 /CD8 ratio increased,while Treg and Treg /CD4 ratio decreased slightly in SSNS group before treatment,but there were no significant differences（P ＆gt; 0.05）.Compared with control group,CD4% and the ratio of CD4 /CD8 increased（P ＆lt; 0.05）,while the ratio of Treg /CD4 decreased significantly（P ＆lt; 0.05） in W4 group.After 8-week treatment,there were no significant differences of CD4%,CD8%,CD4 /CD8 ratio,Treg,and Treg /CD4 ratio（P ＆gt; 0.05）,compared with control group.（3） There were dynamic changes during the treatment in SSNS group.Compared with W4 group,CD4% and CD4 /CD8 ratio were lower（P ＆lt; 0.05）,while CD8%,Treg and Treg /CD4 ratio were higher（P ＆lt; 0.05） in W8 group.But there were no significant differences between W8 group and control group.Conclusion There are changes of T cell populations,T lymphocyte subsets and Treg /CD4 ratio imbalance in PNS adult patients.The disorder immune state even sustained after 4-week treatment of glucocorticoid.It ameliorated after 8-week treatment of glucocorticoid with complete remission.Regulatory T lymphocytes may play an important role in the remission of patients with SSNS.