慢性肾衰血透患者TTV检测及其与细胞免疫功能的关系

Detection of transfusion transmitted virus(TTV) and the relationship between TTV infection and cellular immunity in hemodialysis patients with chronic renal failure

目的 观察慢性肾衰 (CRF)血液透析 (HD)患者中 ,输血传播病毒 (TTV)的感染与患者细胞免疫功能的关系。方法 应用巢式逆转录 -聚合酶链反应 (RT PCR) ,双抗体夹心ELISA法及流式细胞仪 ,分别检测了 90例CRF血透患者和 12 8例对照组血清TTV DNA ,可溶性白细胞介素 2受体 (sIL 2R)和外周血T淋巴细胞亚群。并随机选择对其中1株TTV的部分基因序列进行测定 ,分析TTV与细胞免疫功能、输血次数、HD时间和肝功能的关系。结果 ⑴ 90例CRF血透患者中 ,TTV DNA阳性率为 46 6 7% ,明显高于正常对照组 (P <0 0 0 1) ,与日本报道的TTV DNA序列(AB0 0 8394)相应片段的同源性为 98 5 %。⑵CRF血透患者血清中 ,sIL 2R水平明显高于正常对照组 (P <0 0 1) ;CD3+,CD4+和CD4+/CD8+T细胞比例明显降低 (P <0 0 1)。⑶TTV DNA阳性率与sIL 2R、输血次数及HD时间呈显著的正相关 (r =0 486 ,P <0 0 1;r =0 .5 86 ,P <0 0 0 1;r =0 492 ,P <0 0 1) ,与CD+,CD4+和CD4+/CD8+T细胞比例呈负相关 (r = 0 476 ,P <0 0 1;r = 0 483,P <0 0 1;r= 0 496 ,P <0 0 1) ,而与年龄、性别及手术史均无显著的差别和相关性。结论 CRF血透患者有严重的TTV感染 ;

Aim To investigate the relationship between transfusion transmitted virus(TTV) infection in hemodialysis patients with chronic renal failure(CRF) and cellular immunity. Methods The serum TTVDNA, soluble interleukin2 receptor(sIL2R)and T lymphocyte subsets in 90 CRF hemodialysis patients and 128 controls were detected by nested RTPCR,SandwichELISA and flow cytometry. Furthermore, a partial sequence of TTV genes was randomly selected and determined. The relationships between TTV and transfusion times, long or short duration of hemodialysis, liver function and cellular immunity were analysed. Results ⑴ The positive rates of detected TTVDNA (4667% ) in 90 hemodialysis patients were significantly higher than those in control group(P<0001)and the homology reached 985% in comparison with the segment of TTVDNA sequences reported by Japanese.⑵ In the serum of hemodialysis patients, sIL2R level increased significantly in comparison with that in the normal control(P<001), and CD3+,CD4+ T cells and CD4+ /CD8+ T cells markedly decreased(P<001). ⑶ The positive rate of detected TTVDNA was positively correlated with the transfusion times, duration of hemodialysis and sIL2R level (r=0586, P<0001; r=0486, P<001; r=0492, respectively, P<001), and it was negatively correlated with CD3+ , CD4+ T cells and CD4+ /CD8+ T cell ratio (r=0476, P<001; r=0483, P< 001;r=0496, respectively P< 001), whereas it was not correlated with age, sex and surgery. Conclusion There is a severe TTV infection in hemodialysis patients with CRF, which may be related to the transfusion times and the low cellular immune function.