血液透析患者红细胞免疫功能研究

Investigation about immune function of red blood cell in patients with hemodialysis

目的观察血液透析患者红细胞表面受体CD35的表达及氧化应激的状态，评估红细胞免疫功能的变化，探讨血液透析患者感染及肿瘤高发的原因。方法选择我院血液净化中心维持性血液透析患者45例为治疗组，同期45名健康体检者为对照组，流式细胞仪检测红细胞表面受体CD35的变化，红细胞黏附花环实验检测黏附功能的变化及ELISA方法检测氧化应激指标红细胞超氧化物歧化酶（SOD）、血清丙二醛（MDA）、过氧化氢酶（CAT）、谷胱甘肽过氧化物酶（GSH—PX）的变化。结果与对照组相比，治疗组红细胞表面受体CD35显著降低[分别为（28．62±6．95）Au与（19．71±4．89）Au，t=5．441，P〈0．01]，红细胞黏附功能显著降低（肿瘤细胞花环率分别为0．63±0．07与0．44±0．04，t=0．41，P〈0．05），MDA浓度显著升高[分别为（6．18±0．16）μmol／L与（13．47±0．39）μmol／L，t=13．14，P〈0．05]，SOD[分别为（34202．00±1634．00）U／（g·Hb）与（24652．00±2179．00）U／（g·Hb），t=20．246]、CAT[分别为（21．70±0．84）U／ml与（14．80±1．13）U／ml，t=9．496]、GSH—PX[分别为（444．00±10．31）u与（217．89±13．70）U，t=27．195]均显著降低（P均〈0．05）。结论血液透析患者红细胞表面受体CD35数量及免疫黏附功能均下降，其机体存在高的氧化应激状态，可能是血液透析患者感染及肿瘤高发的原因。

Objective To investigate the expression levels of the red blood cell surface receptors and oxidative stress of patients with hemodialysis, evaluate the immune function of the red blood ceils, and identify the cause of infection and high prevalence of tumor in patients with hemodialysis. Methods Forty-five long-term hemodialysis patients from our blood purification center was chosen as the treatment group. Forty-five healthy individuals conducting physical examination at the same period was chosen as the control group. The flow cytometric method was used to detect CD35 surface receptors numbers of the red blood cell. The red blood ceils wreath experiments were used to measure the adhesive function. The ELASA method was used to test the changes of oxidative stress index ： SOD, MDA, CAT and GSH-PX. Results Compared to the normal control group, the treatment group had significantly lower levels of CD35 [ （28.62 ± 6. 95 ） AU vs. （ 19. 71 ±4. 89） AU, t = 5.441, P 〈 0. 01 ], impaired adhesive function red blood cells [ （0. 63 ±O. 07 ） vs. （0. 44 ± 0.04 ）, t=0. 41, P 〈 0. 05 ]. For the levels of oxidative stress index, MDA [ （ 6. 18± O. 16 ） μmol/L vs （ 13.47± O. 39 ） μmol/L ] was significantly higher in the treatment group than in the normal control group （t = 13.14, P 〈 0.05 ）, and SOD （34 202. 00 ± 1634.00 ） U/（ g Hb ）, CAT （ 21.70 ± O. 84 ） U/ml and GSH-PX （ 444. 00± 10. 31 ） U/ml were significantly lower in the treatment group than in the normal control group [ SOD ： （ 24 652. 00 ± 2179.00） U/（g Hb） ,CAT： （ 14. 80 ± 1.13 ） U/ml, GSH-PX： （217.89 ± 13.70） U, t = 20. 246,9. 496,27. 195, P 〈 0. 05 ]. Conclusion Patients with hemodialysis had lower numbers of red blood cell surface receptors CD35 and impaired immune function of adhesion, and higher oxidative stress levels. This may be the cause of infection and tumor of patients with hemodialysis.