骨化三醇对血液透析患者T淋巴细胞亚群及SIL-2R的影响

目的 :探讨慢性肾功能衰竭 (CRF)维持性血透患者口服骨化三醇对T淋巴细胞亚群及可溶性白介素 2受体 (SIL 2R)的影响。方法 :将 4 0例血透患者根据PTH浓度分为A组 (PTH >2 0 0 pg/mL ,2 2例 )和B组 (PTH <10 0 pg/mL ,18例 )。A组给予骨化三醇治疗 8周 ,B组未服用。采用放射免疫法测定治疗前、后血浆PTH ,采用流式细胞分析技术检测两组患者末梢血T淋巴细胞亚群数量 (CD3 、CD4、CD8、CD4/CD8) ,ELIS方法检测可溶性白介素 2受体 (SIL 2R)的T淋巴细胞数量。结果 :两组CD3 、CD4、CD4/CD8均低于正常对照组 ,且A组低于B组。A组PTH与CD8和SIL 2R均呈显著性正相关 (CD8:r =0 .75 2 ,P <0 .0 1;SIL 2R :r =0 .74 8,P <0 .0 1) ;B组PTH与SIL 2R无相关性 (r =0 .0 0 4 ,P >0 .0 5 )。经骨化三醇治疗 8周后 ,A组血PTH、P3 + 显著性降低 ,而B组无明显变化。结论 :血透患者血浆PTH增高是导致细胞免疫功能降低的重要因素 ,给予骨化三醇治疗可降低血浆PTH水平 ,并可显著改善细胞免疫状态

Effect of 1,25-(OH)2D3 on T lymphocyte Subgroup and SIL-2R in Patients Undergoing Hemodialysis

Objective To investigate the effect of 1,25-(OH)_(2)D_(3) on T lymphocyte subgroup and SIL-2R in patients with chronic renal failure who undergo long-term hemodialysis (HD). Method 40 patients were divided into two groups: group A(PTH>200 pg/mL)including 22 patients and group B(PTH<100 pg/mL) including 18 patients.The patients in group A were given 1,25-(OH)_(2)D_(3) for 8 weeks, but group B were not given 1,25-(OH)_(2)D_(3). Before and after treatment, the plasma levels of parathyroid hormone, was measured by radio-immunity technique, the number of T-lymphocyte subgroup was detected by flow cytometry, the expression of SIL-2R receptor was detected by ELISA method. Results The Level of CD_(3)、CD_(4)、CD_(4)/CD_(8) was significantly less in group A than that in control (P<0.01), So it was that between Group B and control (P<0.05). In group A, the plasma level of PTH negatively correlated with level of CD3(r=-0.765, P<0.01), and plasma level of PTH positively correlated with number of SIL-2R (r=0.748, P<0.01). After using 1,25-(OH)_(2)D_3 for 8 weeks, the levels of PTH, P~(3+), SIL-2R decreased in group A, the numbers of CD_(4)、CD_(4)/CD_(8)and the serum Ca~(2+) increased (P<0.01), but all the parameters remained almost unchanged in group B. Conclusion The high plasma level of PTH is an important factor that lead to cellular immunity decline in patients undergoing hemodialysis. 1,25-(OH)_(2)D_(3 )can improve T lymphocyte function significantly by reduce the level of PTH in these patients.