尿毒症患者淋巴细胞亚群改变的研究

Study of the lymphocyte subset changes in uremic patients

目的了解尿毒症患者淋巴细胞亚群的改变。方法采用血液细胞计数仪对血液细胞进行分类与计数;使用单激光三色流式细胞仪,分析带荧光标记单克隆抗体染色的淋巴细胞及其亚群。结果①血常规计数表明:尿毒症患者存在淋巴细胞减少症(P<0.005),中性粒细胞百分比高于正常对照组(P<0.005);②淋巴细胞亚群分析提示:尿毒症患者CD3+、CD4+、CD8+细胞百分数以及CD4/CD8比值,与正常对照组相比差异无显著性(P>0.05);NK细胞百分数明显增高(P<0.005),透析组CD8+细胞数较未透析组增加[(27.45±7.26)%Vs(20.33±7.01)%,P=0.042],单核细胞数高于正常对照组[(75.6±9.68)%Vs(63.98±12.82)%P=0.039];B淋巴细胞数低于正常对照组[(4.33±1.69)%Vs(9.49±3.30)%P=0.001];③尿毒症患者表现为Th2细胞优势(P<0.05),Th1/Th2比值显著降低(P<0.05),长期透析后上述表现无改善。结论尿毒症患者T细胞亚群表现为Th2优势,透析患者存在B淋巴细胞减少,淋巴细胞亚群的这些改变可能参与了血液透析患者免疫功能下降的发病机理。

Objective To investigate the lymphocyte subset changes in uremic patients. Methods Peripheral blood cells of uremic patients and normal corntrols were differentially counted with automated blood cell counter. Lymphocyte subsets stained with monoclonal antibodys labeled with fluorescent against CD3, CD4, CDS, CD14, CD16, CD19, CD56, IFN-γ and IL4 were examined by three-color flow-cytometry. Results Lymphopenia , both percentage value and absolute counts, and increased percentage of NK cells were found in uremic patients（P〈0. 005）. The HD patients showed decreased B lymphocyte （4.33 ± 1.69% Vs 9.49±3.30% P=0. 001） and increased percentage of monocyte （75.6 ± 9.68% VS 63.98 ± 12.82% P = 0.039） compared with those without receiving HD therarpy. The number of leukocyte and the percentage of CD3^＋, CD4^＋, and CD8^＋ showed no significant changes among uremic patients and control group. The Th1/Th2 ratio was decreased markedly in uremic patients （P〈0.05）.Conclusions Uremic patients showed Th2 predominance. Lymphopenia and Thl/Th2 imbalance may contribute to the immuno-insufficiency in HD patients.