狼疮性肾炎患者淋巴细胞亚群比率和免疫球蛋白水平的变化

Alteration of cellular immunity and immuno-globulins and their relationship in the patients with lupus nephritis

目的 探讨狼疮性肾炎（ＬＮ）患者的淋巴细胞亚群和免疫球蛋白（Ｉｇ）的变化及其意义。方法采用淋巴细胞的膜抗原双标记染色法及ＥＬＩＳＡ，对６０例ＬＮ患者的细胞与体液免疫功能进行前瞻性研究。结果①与对照组相比较，活动期ＬＮ患者的ＣＤ３＋ＣＤ４＋细胞的比率（Ａ组：伴肾病综合征者）为（ｌ６．３ ±７．９）％，Ｂ组（不伴肾病综合征者）为（２０．８±１０．１）％］和ＣＤ１６＋＋ＣＤ５６＋细胞的比率［Ａ组为（８．６±５．７）％，Ｂ组为（１５．２±６．２）％明显减少；ＣＤ３+ ＣＤ8+”细胞的比率［Ａ组为（４８．３±１０．７）％，Ｂ组为（３５．９±９．８）％］明显增高；ＣＤ３+ ＣＤ４+ ／ＣＤ３+ ＣＤ８＋细胞的比值＜１（Ａ组为０．４３±０．２１，Ｂ组为０．８７±０．２５），且Ａ组与８组相比较差异明显（Ｐ＜０．０５）。②与活动期ＬＮ患者相比较，治疗后处于稳定期的 ＬＮ患者 ＣＤ３＋ＣＤ４＋细胞的比率卜组为（２８．８±８．ｌ）％，Ｂ组为（３２．８± ７．ｌ）％］和 ＣＤ１６＋＋ＣＤ５６＋细胞的比率［Ａ组为（１８．９ ± １２．５）％，Ｂ组为（２４．０±８． ９）％，以及 ＣＤ３＋ＣＤ４＋／ＣＤ３＋ＣＤ８＋细胞的比值（Ａ组为 ０．９７±２．３。

Aim To investigate the changes of lymphocytic subsets in peripheral blood and levels of serum immunoglobulins in the pa- tients with lupus nephritis( LN). Methods Experimental grouping: 60 cases of LN patients were divided into two groups, complicated nephritic syndrome (29 cases, group A) and uncomplicated syn- drome (31 cases, group B). Control group was 40 cases of healthy volunteers. The partial surface markers (CD) of peripheral blood lymphocytes were analysed by flowcytometry with double-labeling anti-CD3, anti-CD19, anti-CD16, anti-CD56, anti-CD4, and anti- CD8 mAbs, while the levels of serum IgE, IgG, IgA, and IgM were detected by ELISA. Results ①The percentages of CD3 + CD4 + cells in group A( 16.3 ±7. 9)% and group B(20. 8±10. 1 )% were lower than that in control group ( 37. 6 ±7. 8) %; the percentages of CDl6^++CD56^+cells in group A( 8.6 ±5.7)% and group B (15. 2 ±6. 2) % were lower than that in control group ( 23. 5 ± 11. 6)%; but the percentages of CD3^+ CD8^+ cells in group A( 48.3 ±10.7)% and group B (35.9 ±9.8)% were higher than that in control group ( 23.8 ±5.5)%; the ratio of CD3^+ CD4^+/CD3^+ CD8^+cells in group A( 0.43 ±0.21) and group B ( 0.87 ±0.25) was lower than that in control group (1.55 ±0.47) (P_A <0.001, P_B <0.05; group A was lower than group B, P<0.05 ). ②The percentages of CD3^+ CD4^+ cells and CD16^+ + CD56^+ cells and the ratio of CD3^+ CD4^+/CD3^+ CD8 ^+ cells of the patients at stable stage were higher than those at active stage (P <0.05 or P <0.01); the percentage of CD3 + CD8 + cells of the patients at stable stage was lower than that at active stage (P <0. 05). ③ Levels of the serum IgE in group A (481.2±345.8) kU/L and group B (231.8 ± 111. 2) kU/L of LN patients was higher than that in control group (71.8 ±41.5)kU/L(P^A <0.001, P^B <0.05; group A was higher than group B, P <0. 05 ); levels of the serum 1gM and lgA in group A (3.6±2. 3)g/L and group B (3.5 ±1. 9)g/L were higher than those in control group (1.9 ±0.7)g/L(P<0.05); the serum IgG level (6. 2 ±4. 4) in group A was lower than that in control group (15.2 ±6.4)g/L(P<0.OOl). In contrast serum IgG level in group B (29.3 ±19.2) was higher than that in the control group (P <0. 001); serum lgG level in group A was lower than in group 13 (P <0. 001). Conclusion It is suggested that cellular and humor- al immunities are abnormal in LN patients. When the ratio of CD3^+ CD4~ + /CD3~ + CD8^+ cells less than one, this indicates that there is renal injury.