儿童原发性肾病综合征激素治疗前后免疫学指标的变化及意义

Changes and Significance of the Immunological Indicators in Children with Primary Nephrotic Syndrome

目的探讨原发性肾病综合征(PNS)患儿激素治疗前后外周血淋巴细胞亚群、细胞因子IL-2、IL-4及免疫球蛋白的变化。方法选择初发PNS的患儿46例,采用流式细胞仪检测外周血淋巴细胞亚群[CD3+、CD4+、CD8+、CD4+/CD8+、CD19+、CD(16+56)+];放射免疫法检测血清白细胞介素-2(IL-2)、IL-4的水平及散射比浊法检测血清免疫球蛋白(IgGI、gMI、gA)含量,其中36例激素敏感者于缓解期复查以上指标。选择20例健康儿童为对照组。结果①PNS活动期患儿CD3+、CD4+、CD4+/CD8+、CD(16+56)+细胞均低于缓解期和对照组(P<0.01),CD19+细胞高于缓解期和对照组(P<0.01);CD8+细胞与缓解期和对照组比较差异无统计学意义(P>0.05);缓解期患儿仅CD4+细胞较正常对照组显著降低(P<0.01),其余淋巴细胞亚群数与正常对照组比较均无统计学意义;②活动期IL-2水平均较缓解期组和对照组显著降低(P<0.01),IL-4水平则均显著升高(P<0.01);缓解期IL-4水平虽显著低于活动期,但仍高于正常对照组;③活动期IgG与缓解期和对照组比较均有降低(P<0.01),IgMI、gA无变化。结论PNS患儿存在细胞免疫功能低下,且淋巴细胞亚群间比例失调,细胞亚群的检测可作为肾病活动指标之一;PNS患儿活动期IL-2表达降低,IL-4升高,存在Th1/Th2平衡失调;PNS患儿活动期血清IgG明显降低。

Objective To investigate changes of peripheral blood lymphocyte subsets, cytokines IL-2, IL-4 and immunoglobulin in children with primary nephrotic syndrome and to understand their role in the pathogenesis. Methods 46 cases with PNS were given prednisone acetate（1.5 - 2mg/kg.d）after diagnosis and the steroid effects were observed. 20 healthy children were selected randomly as control group simultaneously. Before steroid therapy （active stage）, the ratios of peripheral blood lymphocyte subsets [ CD3^＋ , CD4^＋ , CD8^＋ , CD4^＋/CD8^＋ , CD19^＋ , CD（ 16 ＋ 56）^＋ ] were analyzed by flow eytometry （FCM）, eytokines IL-2 （IL-2）, IL-4 were assessed by radio-immunoassay and the levels of serum immunoglobulin （IgG, IgM, IgA） were measured by scattering nephelometry. Among 36 eases that were steroid-sensitivity, these indicators were reexamined at the remission stage. Results 1. Changes of peripheral blood lymphocyte subsets： The ratios of CD3^＋, CD4^＋, CD4^＋/CD8^＋, CD（16 ＋ 56）^＋ at the active stage were significantly lower than those at the remission stage and control group, while CD19^＋ was significantly higher than those at the remission stage and control group （P 〈 0.01 ）. When compared CD8^＋ at the active stage and remission stage or control group, no significant difference was found. 2. Changes of cytokines IL-2 and IL-4：IL-2 level at the active stage was significantly lower （P 〈 0.01 ） than that at the remission stage and control group, while IL-4 level was significantly higher （P 〈 0.01 ） than that of remission stage and control group and there were significant differences. 3. Changes of immunoglobulin ： IgG at the active stage were significantly lower than that at the remission stage and control group （P 〈 0.0! ）, while IgM, IgA did not change. Conclusion 1. Children with PNS showed decreasing of cell immune function and imbalance of lymphocyte subsets. 2. The lower expression of cytokines IL-2 and higher expression of IL-4 in PNS process, indicated the imbalance of Th1/Th2 and cytokines. 3. The peripheral blood IgG decreased significantly in children with PNS.