原发性肾病综合征患者外周血共刺激分子CD28的表达及其临床意义

目的研究原发性肾病综合征(PNS)患者外周血共刺激分子CD28的表达变化特点,以及这种变化与激素敏感性的关系,探讨其在PNS免疫发病机制中的作用。方法采用免疫荧光标记和流式细胞仪分析方法,对32例PNS患者外周血T细胞亚群和共刺激分子CD28的表达进行研究。结果(1)肾病综合征发作组(包括激素有效组和无效组)共刺激分子CD28表达明显低于正常对照组,差异有统计学意义(P<0.001),并且CD4 CD28 T细胞和CD8 CD28 T细胞均明显低于正常对照组,差异有统计学意义(P<0.01)。(2)激素有效组尿蛋白转阴后CD28分子水平明显上升,且CD4 CD28 T细胞和CD8 CD28 T细胞均较治疗前明显上升,差异有统计学意义(P<0.01);而激素无效组上述三个指标在激素治疗前后的变化无统计学意义(P>0.05)。(3)不完全缓解组和持续缓解组CD28 T细胞、CD4 CD28 T细胞和CD8 CD28 T细胞均恢复至正常对照组水平。(4)首发和复发患者之间共刺激分子CD28、CD4 CD28 T细胞和CD8 CD28 T细胞之间的差异无统计学意义(P>0.05)。结论PNS患者外周血T细胞活化所必需的共刺激分子CD28异常表达可能在PNS发生和病变进展中起着重要作用;糖皮质激素可使PNS患者外周血CD28异常表达被逐渐纠正,可能是其治疗肾病综合征的机制之一。

The Expression of the Costimulatory Molecule CD28 and Its Clinical Significance in Patients with Primary Nephrotic Syndrome

Objective To investigate the expression of the costimulatory molecule CD28 on PBMC(peripheral blood mononuclear cells) and the significance of its change after therapy in patients with primary nephritic syndrome(PNS).Method The expression of CD28 and T lymphocyte subsets from 32 patients with primary nephrotic syndrome were studied by immunophenotyping and flow cytometry analysis.Results(1)The expression of the costimulatory molecule CD28 on PBMC in patients with PNS(including sensitive to corticosteroid and insensitive to corticosteroid) was significantly lower than that of normal controls(P<0.001),meanwhile the percentage of both CD4 CD28 T cells and CD8 CD28 T cells was decreased markedly(P<0.001).(2)CD28 T cells,including CD4 CD28 T cells and CD8 CD28 T cells increased significantly in complete remission patients After the efficient treatment with corticosteroid(P<0.01).(3)There was no marked change of the CD28 expression and the levels of CD4 CD28 T cells and CD8 CD28 T cells in both complete and partial remission patients in comparison with those of normal controls.(4)No significant difference was found between primary and relapse patients.Conclusion The abnormal expression of the costimulatory molecule CD28 needed for autoreative T cell may play an important role in the pathogenesis of primarynephroticsyndrome.The corticosteroid therapy may improve the imbalance of CD28 in patients with primary nephrotic syndrome.