激素抵抗型肾病综合征患者T淋巴细胞亚群及调节性T细胞的变化及意义

目的探讨激素抵抗型原发性肾病综合征（ SRNS）患者T细胞亚群（ CD3＋CD4＋、CD3＋CD8＋、CD4/CD8）及Treg（CD4＋CD25＋highCD127low）的动态变化趋势及临床意义。方法选取初治原发性肾病综合征（PNS）患者65例，标准剂量泼尼松治疗（1 mg·183; kg-1·183; d-1）8周后，根据病情缓解与否筛选出SRNS组患者24例。正常对照组30例。患者于治疗前（W0）、治疗4周（W4）、治疗8周（W8）采用流式细胞术检测T细胞亚群及Treg。结果①SRNS组激素治疗8周后，除Alb较治疗前有所升高外（ P＜0.05），尿蛋白定量、血肌酐（Scr）、尿素氮（BUN）、胆固醇（Cho）、甘油三酯（TG）治疗前后差异无统计学意义（P＞0.05）。②SRNS组患者W0与正常对照组比较，CD4％、CD4/CD8升高，而Treg/CD4下降（ P＜0.05）。 SRNS组治疗8周后与治疗前比较，CD4％、CD8％、CD4/CD8、Treg、Treg/CD4差异均无统计学意义（ P＞0.05）。结论 SRNS患者存在T细胞数量异常，T细胞亚群及Treg/CD4比值失调情况。糖皮质激素治疗8周未能有效改善其临床表现及免疫异常状态。

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

Objective To investigate the change trend of T lymphocyte subsets （ CD3 ＋CD4 ＋,CD3 ＋CD8 ＋, CD4/CD8） and regulatory T cells（Treg,CD4 ＋CD25 ＋highCD127low） in adult patients with steroid-resistant nephrotic syndrome（SRNS） and its clinical significance.Methods Twenty-four SRNS patients enrolled in SRNS group were chosen from 65 inpatients with primary nephrotic syndrome （PNS） first treated with prednisone （1 mg·183; kg-1 ·183; d-1 ） for eight weeks , according to the state of clinical remission of PNS .Thirty normal persons were served as healthy con-trol group.T lymphocyte subsets and Treg were detected by flow cytometry before treatment （W0 group）, after 4-week treatment（W4 group） and after 8-week treatment（W8 group）.Results ①Compared with W0 group, plasma albu-min（ Alb） increased significantly （ P〈0.05 ） , while urinary protein , serum creatinine （ Scr ） , blood urea nitrogen （BUN）, cholesterol（Cho）and triglycerides（TG） had no significant differences in W8 group（P〈0.05）.②Com-pared with control group , CD4%and CD4/CD8 ratio increased significantly , while Treg/CD4 ratio decreased signifi-cantly in W0 group（P〈0.05）.Compared with W0 group,CD4%,CD8%,CD4/CD8,Treg and Treg/CD4 had no sig-nificant differences in W8 group（P〈0.05）.Conclusion There are changes of T cell populations , T lymphocyte subsets and Treg/CD4 ratio imbalance in SRNS adult patients .The clinical manifestation and the disorder immune state even sustained after 8-week treatment of glucocorticoid .