Th1/Th2平衡关系与IgA肾病临床、病理表现的相关性分析

The Correlation Analysis of Th1/Th2 Balance and Clinical and Pathological manifestations in IgA Nephropathy

目的探讨辅助性T(Th)1/Th2细胞平衡与IgA肾病(IgAN)临床、肾脏病理表现的相关性。方法采用流式细胞术检测40例IgAN患者与20例健康人对照组外周血Th1、Th2值;收集IgAN患者慢性扁桃体炎史和反复发作性肉眼血尿史,血清胆固醇(Tch)、三酰甘油(TG)、IgG、IgA、内生肌酐清除率(Ccr),24 h尿蛋白及肾脏病理表现;并了解IgAN患者以上情况与Th1/Th2比例的相关性。结果 IgAN患者外周血中Th2细胞比例为(1.77±0.90)%,较健康对照组的(1.18±0.15)%升高(P<0.01)。慢性扁桃体炎对Th1/Th2比例无明显影响;有反复发作性肉眼血尿的IgAN患者Th1细胞比例(8.50±4.68)%及Th1/Th2值(4.10±2.01)均较无反复发作性肉眼血尿IgAN患者高(P<0.05),24 h尿蛋白定量大于1.0 g/d IgAN患者的Th1细胞比例(2.55±1.20)%及Th1/Th2值(1.58±0.43)均较小于1.0 g/d的患者(P<0.01);多元线性回归分析显示IgAN患者外周血Th1/Th2比值与血清中IgG/IgA值存在着正相关关系。结论 IgAN患者存在Th2细胞型免疫表达增强,可能与IgA肾病的免疫机制有关;反复发作性肉眼血尿及24 h尿蛋白小于1.0 g/d的IgAN患者外周血的Th细胞亚群呈Th1偏移;IgAN患者的血清中IgG/IgA值对外周血中Th1/Th2比值存在着正相关影响。

Objective To explore the relevance of the helper T（Th） 1/Th2 cells balance and clinical pathological manifestations in IgA nephropathy.Methods To evaluate this relevance,we detected the values of Th1 and Th2 in peripheral blood of 40 IgA nephropathy patients and 20 controls by using flow cytometry.Histories of tonsillitis and recurrent attacks of gross hematuria,levels of serum Tch,TG,IgG,IgA,CCr and renal pathology manifestation in IgA nephropathy patients were collected.Then we analyzed the effects of Th1/Th2 balance in IgA nephropathy patients.Results Compared with healthy control group,the value of Th2 cells was higher in IgA nephropathy [（1.18±0.15）% vs（1.77±0.90）%,P〈0.01].The values of Th1 cells and Th1/Th2 in the patients with recurrent attacks of gross hematuria were（8.50±4.68）% and 4.10±2.01 respectively,which were significantly higher than those in the controls [（4.04±3.23）% and 2.42±1.50].Compared with the corresponding group,the values of Th1 and Th1/Th2 in IgAN patients with 24-hour urine protein〉1.0 g/d was more than those 〈1.0 g/d（P〈0.01）.There was a positive correlation between the value of IgG/IgA in serum and the ratio of Th1/Th2 in IgAN.Conclusion The over-expression of Th2-cell in IgAN may be related with IgA nephropathy immune mechanisms;The Th cell subsets in progresses of gross hematuria and 24-hour urine protein of less than 1.0 g/d show offset of Th1 cells;The value of IgG/IgA in serum has a positive effect on the ratio of Th1/Th2 in IgAN.