维持性血液透析对T细胞亚群与红细胞生成素低反应性的影响

Relationship between T cell subsets and hyporesponsiveness to erythropoietin in maintenance hemodialysis patients

目的通过对红细胞生成素（rHuEPO）不同反应的患者用流式细胞仪检测T细胞亚群以了解rHuEPO低反应与细胞免疫的关系及可能的作用机制。方法将40例维持性血液透析（MHD）患者按照rHuEPO反应的不同分为第一组和第二组，rHuEPO反应低下的18例为第一组，rHuEPO反应良好的22例为第二组，另设一健康对照组20例。应用流式细胞仪检测各组患者T淋巴细胞表面CD4＋、CD8＋、CD4＋／CD5、CD8＋／CD28＋抗原的表达情况。结果rHuEPO反应良好组和反应低下组的CD4^＋T细胞、CD8＋T细胞百分比差异无统计学意义，但均显著低于对照组；rHuEPO反应低下组的CD4^＋CD28＋/CD4＋、CD8＋CD28＋／CD8＋T细胞的百分比明显低于反应良好组和对照组，而反应良好组与对照组之间无明显差异。结论尿毒症MHD患者存在T细胞免疫表型的改变。

Objective One hypothesis is that patients with uraemia showing hyporesponsiveness to rHuEPO may have enhanced levels of immune activation causing increased release of inflammatory cytokines. To study the effects of chronic inflammation on the hyporesponsiveness to rHuEPO and its possible mechanisms, T cell phenotypes using flow cytometry and the relationship between these changes were detected. Methods 40 patients with MHD and 20 age-matched healthy volunteers were enrolled in the study. The MHD patients were divided into two groups according to the responsiveness to rHuEPO： 22 cases with good responders and 18 cases with poor responders. The percentages of T celt subsets including CD4＋, CD8＋, CD4＋/CD28＋, CD8＋/CD28＋ T cell using flow cytometry were detected. Results The percentages of CD4＋ and CD8＋ T cell were lower in MIlD patients than that in control group. The percentages of CD4＋/CD28＋ and CD8＋/CD28＋ T cell were lower in group of poor responders than in good responders. Conclusion Chronic inflammation state is common in MHD patients. The percentages of CD4＋ /CD28＋ and CD8＋ / CD28＋ T cell in poor responders were much lower than good responders. The changes of T cell phenotypes may play a role in pathogenesis of hyporesponsiveness to rHuEPO.