原发性肾病综合征患儿外周血Th17与CD4^+ CD25^+ Foxp3^+调节性T细胞的水平

Level of Th17 cell and CD4^+ CD25^+ Foxp3^+ regulatory T cell in peripheral blood mononuclear cells of primary nephrotic syndrome in children

目的：观察原发性肾病综合征（PNS）患儿外周血Th17细胞和CD4^＋CD25^＋Foxp^3＋调节性T细胞（Treg）及其相关因子的水平和功能，初步探讨其在儿童PNS发病中的作用。方法：PNS患儿分为单纯型肾病（SNS）20例、肾炎性肾病（NNS）15例；同时以20例健康体检儿童作为对照组。采用流式细胞术（FCM）检测外周血单个核细胞（PBMC）中Th17细胞和Treg细胞比例；Real—time PCR法检测PBMC中RORC、IL-23p19和Foxp3 mRNA的表达；ELISA分别检测血清中IL-1β、IL-6、TGF-β1的水平。结果：SNS、NNS组患儿Th17细胞及RORC、IL-23p19mRNA、IL-1β、IL-6的水平均明显高于正常组（P〈0．05），且NNS组患儿以上指标明显高于SNS组（P〈0．05）；SNS、NNS组患儿Treg细胞、Foxp3 mRNA和TGF-β1水平的表达明显低于正常组（P〈0．05），其中两组疾病患儿血清TGF—β1的水平无统计学意义（P〉0．05），其余指标NNS患儿均明显低于SNS组（P〈0．05）。结论：Th17／Treg细胞功能失衡可能在儿童PNS的发病中起到重要作用，其失调程度可能与PNS的临床表现、对激素的敏感性、病理类型、及预后有关。

AIM： To investigate the levels and functions of Th17 cells and CD4^＋ CD25^＋ Foxp^3＋ regulate cells（Treg） and explore their role in pathogenesis of primary nephrotic syndrome （ PNS ） in children. METHODS： Children with PNS were divided into simple type nephritic syndrome group （SNS） （n = 20）, and nephritic type nephritic syndrome group （NNS） （ n = 15）. 20 healthy subjects were selected as control group. The circulating frequencies of Th17 cells and Treg were measured by FCM. Real-time PCR were used to analyze the mRNA expressions of RORC, IL-23p19 and Foxp3 in peripheral blood mononuclear cells. The serum of IL-1β, IL-6, TGF-β1 were measured by ELISA. RESULTS： Circulating frequencies of Thl7 cells, the mRNA levels of RORC, IL-23p19 and the serum of IL-1β, IL-6 were higher in SNS and NNS groups than control group （P 〈 0.05）, and they were higher in NNS group than SNS group （P 〈 0.05）. Compared with control group, the circulating frencencies of Treg cells, the Foxp3mRNA levels and the serum levels of TGF-β1 were lower in NNS and SNS groups （P〈 0.05）, and the circulating frencencies of Treg cells, the Foxp3mRNA levels were lower in NNS group than SNS group（ P〈0.05）, but NNS and SNS group had no statistical difference in the serum levels of TGF-β1 （ P 〉 0.05）. CONCLUSION： Imbalance of Th17 and Treg cells might contribute to the pathogenesis of PNS in children and have associated with clinical presentation, pathological type, glucocorticoid sensitivity and prognosis of the disease.