原发性膜性肾病患者外周血淋巴细胞亚群的变化及其与蛋白尿的关系

Changes of peripheral blood lymphocyte subgroups in patients with primary membranous nephropathy and their relationship with proteinuria

目的分析原发性膜性肾病(PMN)患者外周血淋巴细胞亚群的变化及其与蛋白尿的关系。方法选取新乡医学院一附院肾内科确诊的PMN患者40例,收集其详细临床资料,并留取外周血应用流式细胞仪测定淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+、CD16+CD56+、CD19+),同时选取20例健康志愿者作为健康对照组,比较PMN患者外周血淋巴细胞亚群与健康对照组的差别。根据患者尿蛋白水平,将PMN患者分为大量蛋白尿组(尿蛋白定量大于或等于3.5g/d)及非大量蛋白尿组(尿蛋白定量小于3.5g/d),分析两组患者上述淋巴细胞亚群水平的差异及其可能的临床意义。结果 (1)和健康对照组相比,PMN患者外周血CD4+细胞计数有升高趋势(51.83±6.80 vs.43.5±5.65,P>0.05),CD8+细胞计数有降低趋势(28.83±5.60 vs.35.33±5.00,P>0.05),而CD4+/CD8+比值较健康对照组明显升高(1.86±0.43 vs.1.27±0.33,P<0.01)。与健康对照组比较,PMN患者外周血CD16+56+细胞计数无明显差异,而CD19+细胞计数明显升高(8.00±2.76 vs.7.33±2.66,P<0.01)。(2)和非大量蛋白尿组相比,大量蛋白尿组CD19+细胞计数明显高升高(9.80±3.19 vs.7.10±2.23,P<0.01),而CD4+细胞、CD8+细胞计数、CD4+/CD8+比值两者间差异均无统计学意义(P>0.05)。结论 PMN患者表现出明显的B淋巴细胞异常和CD4+/CD8+细胞比值的偏移,且B淋巴细胞异常程度与蛋白尿量有关,因此,监测PMN患者淋巴细胞亚群变化有助于评估病情、指导治疗。

Objective To analyze the changes of lymphocyte subgroups in peripheral blood for the patients with primary membranous nephropathy（PMN）and their relationship with proteinuria .Methods 40 cases of PMN in the nephrology department of our hospital were selected and their detailed clinical data were collected .The peripheral blood was collected for detecting the levels of lymphocyte subgroups （CD3^＋ ,CD4^＋ ,CD8^＋ ,CD4^＋ /CD8^＋ ,CD16^＋56^＋ ,CD19^＋ ） by the flow cytometry .Simultaneous 20 healthy volunteers were selected as the control group .The differences in peripheral blood lymphocyte subgroups were compared between the PMN patients and the healthy con‐trol group .According to the proteinuria levels ,the PMN patients were divided into the massive proteinuria group （MPG ,proteinuria quantity≥3 .5 g/d） and the non‐massive proteinuria group（NMPG ,proteinuria quantity〈3 .5 g/d） .The differences in peripheral blood lymphocyte subgroups were compared between the MPG group and the NMPG group and their possible clinical significance was investigated .Results （1） Compared with the healthy con‐trol group ,the CD4^＋ cell levels had a rising trend（51 .83 ± 6 .80 vs .43 .5 ± 5 .65 ,P〉0 .05） and the CD8^＋ cell levels had a downward trend（28 .83 ± 5 .60 vs .35 .33 ± 5 .00 ,P〉0 .05） in the PMN patients ,while the CD4^＋ /CD8^＋ ratio was significantly increased compared with the healthy control group （1 .86 ± 0 .43 vs .1 .27 ± 0 .33 ,P〈0 .01） .There was no significant difference in the CD16^＋CD56^＋ count between two groups ,while the CD19^＋ cell count in the PMN patients was significantly increased（8 .00 ± 2 .76 vs .7 .33 ± 2 .66 ,P〈0 .01） .（2） Compared with the NMPG group , the CD19^＋ cell count in the MPG group was significantly increased（9 .80 ± 3 .19 vs .7 .10 ± 2 .23 ,P〈0 .01） ,while the CD4^＋ cell count ,CD8^＋ cell count and the CD4^＋ /CD8^＋ ratio had no statistically significant differences between the MPG and NMPG groups .Conclusion PMN patients appear obvious abnormalities of B lymphocytes and the shift of CD4^＋ /CD8^＋ cells ratio .The abnormal degree of B lymphocyte is related to proteinuria quantity .Therefore ,monito‐ring the lymphocyte subgroups changes can help to assess the disease condition and guide the treatment .