芪加肾康对单纯性肾病综合征患儿T细胞功能障碍的调节作用

Regulation of T Cell Dysfunction by Qijia Shenkang Mixture in Patients with Nephrotic Syndrome

目的 :探讨单纯性肾病综合征 (SSNS)患儿T细胞功能障碍情况及芪加肾康的免疫调节作用。方法 :采用免疫荧光标记和流式细胞仪技术检测了 2 1例激素联合芪加肾康治疗组和 2 7例常规激素治疗对照组患儿治疗前、后CD4+ 细胞表达率、CD4+ /CD8+ 细胞比值、CD3 + /HLA -DR+ 活化T细胞和CD3 + /CD2 5+ 白细胞介素 2受体阳性T细胞的表达情况 ,并对两组的治疗效果进行统计分析。结果 :初发SSNS激素治疗前两组患儿外周血CD4+ 细胞表达率、CD4+ /CD8+细胞比值、CD3 + /HLA -DR+ 活化T细胞和CD3 + /CD2 5+ 表达IL - 2R的T细胞均明显降低。治疗 8个月后缓解期 ,对照组与健康组比较 ,CD4+ 细胞数、CD4+ /CD8+ 细胞比值、CD3 + /HLA -DR+ 活化T细胞的表达仍显著减少 ;而治疗组与健康组比较 ,上述指标已无统计学意义 ;治疗组较对照组CD3 + /HLA -DR+ 活化T细胞的表达率明显增高 (P <0 .0 5 )。对照组 1年停药时 ,累积共反复 11例 ,而治疗组患儿共反复 2例 ,两组比较有统计学差异(χ2 =4 .36 ,P <0 .0 5 )。结论 :芪加肾康对患儿的CD4+ 细胞数和CD4+ /CD8+ 细胞比值失调 ,尤其是对T细胞的活化障碍有明显的调节作用。激素联合芪加肾康治疗能明显减少SSNS的反复。

Objective:To study dysfunction of T cell in patients with steroid-sensitive and simple nephrotic syndrome(SSNS) and the immunoregulatory effects of Qijia Shenkang mixture.Methods:T cell subsets, expression of CD 3 +/HLA-DR + and CD 3 +/CD 25 + membrane molecule on T cells were analyzed by flow cytometry in 21 patients treated with glucocorticoid and Qijia Shenkang mixture and in 27 patients treated with glucocorticoid alone.Results:The expression rate of CD4+ Cells, the ratio of CD 4 +/CD 8 +,CD 3 +/HLA-DR + activated T cells and CD 3 +/CD 25 +T cells expressing IL-2R were lower in SSNS patients than those in healthy control. The CD 4 + Cells, the ratio of CD 4 +/CD 8 +and CD 3 +/HLA-DR + activated T cells were still lower than the healthy controls in patients in remission after 8 month of glucocorticoid treatment, but there were no significant differences between patients treated with glucocorticoid and Qijia Shenkang mixture and the healthy controls. The CD 3 +/HLA-DR+activated T cells were significantly higher in patients with combined treatment(P<0.05). The CD 3 +/HLA-DR+activated T cells were significantly higher in patients relapsed after one year of glucocorticoid treatment than the patients with combined treatment(χ 2=4.36,P<0.05).Conclusion:There were T cell dysfunctions in primary SSNS patients.The Qijia Shenkang mixture is able to regulate the expression of CD4+ T cells and ratio of CD 4 +/CD 8 +, especially the function of CD 3 +/HLA-DR + activated T cells.Patients treated with glucocorticoid and Qijia Shenkang mixture have less relapses.