慢性肾炎患者外周血T细胞亚群和共刺激分子的表达及其意义

为研究慢性肾炎患者外周血T细胞亚群和共刺激分子的表达特点及其在慢性肾炎免疫病理机制中的作用 ,本文采用免疫荧光标记和流式细胞仪分析 ,对 35例慢性肾炎患者外周血T淋巴细胞亚群和共刺激分子CD2 8、 4 1BB等的表达进行研究。结果表明 :(1)慢性肾炎患者T细胞亚群明显失衡 ,表现为CD4减少 ,CD8增加 ,CD4/CD8比值显著降低 ;(2 )共刺激分子CD2 8表达显著低于正常对照组 (CD2 8表达百分率分别为 45 95± 5 6 7和 6 6 42± 4 5 8,P <0 0 0 1) ,且CD4+ CD2 8+ T细胞和CD8+ CD2 8+ T细胞均显著减少。治疗后缓解期患者T细胞亚群失衡明显纠正 ,CD2 8+ T细胞 ,尤其是CD4+ CD2 8+ T细胞显著增多 ,而且CD4+ CD2 8+ T细胞数与患者的 2 4h尿蛋白定量呈负相关 (r= 0 47,P <0 0 1) ;(3)慢性肾炎患者共刺激分子 4 1BB在T细胞中的表达显著高于正常对照组 (表达百分率分别为 30 5 7± 8 12和 0 74± 0 2 8,P <0 0 0 1) ,治疗后的 4 1BB表达水平显著降低 ,而且 4 1BB异常高表达与CD8+ T细胞数呈正相关 (r=0 6 3,P <0 0 5 )。从而表明慢性肾炎外周血T细胞亚群失衡和T细胞活化所必需的共刺激分子CD2 8、 4 1BB异常表达 ,可能在慢性肾炎发生和病变进展中起着重要作用。

Significance of the Abnormal Expression of the Costimulatory Molecules and T Lymphocyte Subsets from Patients with Chronic Nephritis

To investigate the expression and role of the costimulatory molecules and T lymphocyte subsets from patients with chronic nephritis,the expression of the costimulatory molecules,such as CD28?4-1BB on PBMC and T lymphocyte subsets in PBMC from 35 patients with chronic nephritis were studied by immunophenotyping and flow cytometry analysis. The T lymphocyte subsets from patients with chronic nephritis was showed an obvious imbalance with reversing CD4/CD8 ratio,decreasing CD4 +T cells and increasing CD8 +T cells. The expression of the costimulatory molecule CD28 on T cells was significantly lower compared to that of normal controls (45.95±5.67 vs 66.42±4.58,P<0.001),meanwhile the percentage of both CD4 +CD28 +T cells and CD8 +CD28 +T cells was decreased markedly. After treatment the patients were in remission of their disease,the imbalance of T lymphocyte set improved greatly,CD28 +T cells, especially CD4 +CD28 +T cells,increased significantly. In addition,a perfect negative correlation was found between CD4 +CD28 +T cell numbers and the total amount of 24 h urinary protein (r=-0.47,P<0.01). The 4-1BB expression on T cells in active patients was much higher in comparison with that of normal controls (30.57±8.12 vs 0.74±0.28,P<0.01). After treatment the 4-1BB expression in remission patients was decreased significantly. Moreover,correlation were found between the 4-1BB expression and the CD8 +T cell counts (r=0.63,P<0.05). The abnormal expression of the costimulatory molecules CD28 and 4-1BB needed for autoreative T cells and the imbalance of T cell subsets may play an important role in the pathogenesis of chronic nephritis.