淋巴细胞亚群检测在肾病综合征患儿免疫功能评价中的意义

原发性肾病综合征(primary nephrotic syndrome, PNS)是儿童时期常见的肾小球疾病,也是进展为慢性肾衰竭的主要原因。原发性肾病综合征的发病机制尚未明确,但长期研究证实可能与免疫功能紊乱有关,淋巴细胞亚群作为反映机体免疫功能的指标,对于研究PNS的发病机制及指导治疗、预后都具有意义。几十年前已有研究证实T淋巴细胞亚群异常可能与肾病综合征的发病机制有关,在这之后的许多研究进一步证实T淋巴细胞介导的细胞免疫在PNS发病中的主导作用。对于B淋巴细胞介导的体液免疫,近年来多数文献报道Rituximab(CD20单克隆抗体)用于治疗儿童难治性肾病综合征,尤其是激素依赖型和频繁复发型肾病综合征的患儿,可使其得到显著缓解,提示B淋巴细胞功能的异常可能与儿童原发性肾病综合征的发病有关。NK细胞作为人体的一种免疫细胞,对于PNS患儿的预后也有很大的价值,NK细胞水平较低的患儿更易复发,且激素治疗后NK细胞水平较低的患儿发生感染的风险更高,可以看出NK细胞在PNS的发生、发展中有着重要作用。本文主要对T淋巴细胞亚群、B淋巴细胞及NK细胞进行简要综述,探讨它们与PNS的关系。 

Significance of lymphocyte subset detection in immune function evaluation of children with nephrotic syndrome

Primary nephrotic syndrome (PNS) is a common glomerular disease in childhood, and it is also the main cause of chronic renal failure. The pathogenesis of PNS remains unclear, but long-term studies have confirmed that it may be related to immune dysfunction. Lymphocyte subsets, an indicator of immune function, are of great significance in studying the pathogenesis, guiding treatment and predicting the prognosis of PNS. Decades ago, studies have confirmed that T lymphocyte subsets may be related to the pathogenesis of nephrotic syndrome. Many studies have also confirmed the dominant role of T lymphocyte-mediated cellular immunity in the pathogenesis of PNS. In recent years, Rituximab (CD20 monoclonal antibody) has been used to treat children with refractory nephrotic syndrome, especially in children with steroid-dependent and frequent relapse nephrotic syndrome. It suggests that the abnormal function of B lymphocytes may be related to the occurrence of childhood PNS. NK cells, a kind of immune cells in the human body, are also of great value for the prognosis of children with PNS. Children with lower NK cell levels are more likely to relapse and are more likely to have the risk of infection after hormone therapy. NK cells play an important role in the occurrence and development of PNS. This article mainly summarises T lymphocyte subsets, B lymphocytes and NK cells, and discusses their relationship with PNS.