糖皮质激素对原发性肾病综合征患儿T辅助细胞平衡的影响

The effects of steroids-therapy on T helper cells balance in childhood primary nephrotic syndrome

目的 探讨糖皮质激素治疗对原发性肾病综合征患儿TH1/TH2平衡的影响。方法 运用三色荧光标记法流式细胞术检测 2 1例初发 (NS组 )和 15例复发 (NS +Pred组 )的肾病患儿外周血TH1和TH2细胞百分率 (% ) ,并以 9例缓解期患儿 (NS缓解 +Pred组 )和 10例正常儿童 (正常组 )作对照。结果 正常儿童外周血TH1、TH2细胞百分率分别为 (13.42± 4.36 ) %和 (2 .5 3± 1.97) %。初发的原发性肾病患儿均明显减低 (P <0 .0 5 ) ,分别为 (2 .34± 2 .0 9) %和 (1.0 2± 0 .96 ) %。复发的肾病患儿除TH1细胞百分率减低 [(1.2 0± 0 .91) % ,P <0 .0 1]、TH2细胞百分率增高 [(7.6 5± 4.5 3) % ,P <0 .0 1)外 ,TH1细胞百分率也较初发病例进一步下降 (P <0 .0 5 )。缓解期肾病患儿TH1和TH2细胞百分率均正常 ,分别为 (12 .0 4± 4.92 ) %和 (2 .81± 2 .6 5 ) % (P >0 .0 5 )。TH1/TH2比值在正常儿童为 5 .41± 2 .77,在初发的肾病患儿明显减低 (2 .43± 2 .6 5 ,P <0 .0 5 ) ,在复发的患儿较初发患儿进一步下降 (0 .77± 1.0 7,P <0 .0 5 ) ,在缓解患儿则正常 (4 .2 5± 2 .12 ,P >0 .0 5 )。肾病患儿也存在着Tc2细胞占优势的免疫平衡失调。结论 糖皮质激素在体内是通过促进TH2细胞向TH1细胞迁移 。

Objective To investigate the effects of steroids-therapy on T H1/T H2 balance in childhood primary nephrotic syndrome(PNS). Methods Determination of T-helper (T H) -1 and T H2 cells percentage in 21 on-going cases of PNS without prednisone therapy, 15 relapse cases of PNS with prednisone therapy and 9 remission cases of PNS with prednisone therapy by three-color flow-cytometry following whole blood cells culture, compared with 10 healthy children. Results The percentages of T H1 and T H2 cells in healthy children were (13.42± 4.36)% and (2.53±1.97)% respectively. In the patients with on-going PNS, the percentages of T H1 and T H2 cells were significantly decreased [(2.34±2.09)% and (1.02±0.96)% respectively, P<0.05]. In the patients with relapse PNS, the percentage of T H1 cells was also significantly decreased [(1.20±0.91)%, P< 0.01], but the percentage of T H2 cells was significantly increased [(7.65±4.53)%, P<0.01], and the decrease of T H1 cells was more obvious than in onset(P<0.05). In the remission patients with PNS, the T H1 and T H2 cells percentages were normal [(12.04±4.92)% and (2.81±2.65)% respectively, P>0.05)]. On the other hand, T H1/T H2 ratio was 5.41±2.77 in healthy children, normal in the remission patients with PNS(4.25±2.12, P>0.05), low in the patients with PNS in onset (2.43±2.65,P<0.05) and lower in relapse cases than in onset (0.77±1.07, P<0.05). Conclusion The beneficial effects of steroids-therapy can be explained by the shift from the T H2 cells to T H1 cells in children with primary nephrotic syndrome, which is primarily caused by the relatively predominant T H2 cells in vs T H1 cells.