IL-17和IL-23在成人原发性肾病综合征患者中的变化及意义

The variation and significance of IL-17 and IL-23 in adult patients with primary nephrotic syndrome

目的观察白细胞介素17(IL-17)和白细胞介素23(IL-23)在成人原发性肾病综合征(PNS)中的变化,探讨其在PNS发生及发展中的作用及临床意义。方法选取初次就诊并激素治疗有效的PNS住院患者35例(实验组),按常规剂量给予强的松治疗;选取同期健康体检者20名作为对照组。检测对照组、PNS患者治疗前和完全缓解时的外周血T细胞亚群及血清和24 h尿液中IL-17、IL-23、白细胞介素6(IL-6)水平,并分别与24 h尿蛋白定量进行相关分析。结果与对照组相比,PNS患者外周血CD3+、CD3+CD4+细胞数减少(P<0.05),血清IL-17、IL-6和24 h尿液中IL-17、IL-23、IL-6水平明显增加(P<0.05);经治疗,PNS患者CD3+、CD3+CD4+细胞数较治疗前明显增加(P<0.05),24 h尿液中IL-17、IL-23、IL-6水平较治疗前明显降低(P<0.05)。PNS患者血清IL-17、IL-23水平和24 h尿液IL-17、IL-23水平均与24 h尿蛋白定量呈显著正相关(P均<0.01)。结论 IL-17和IL-23可能与PNS患者大量蛋白尿的形成有关;激素治疗能够显著改善PNS患者细胞免疫功能紊乱和T细胞亚群失衡;监测PNS患者血清和24 h尿液中IL-17和IL-23的水平,可能有助于病情的判断和指导临床治疗。

Objective To investigate the changes of interleukin 17（ IL-17） and interleukin 23（ IL-23） in adult patients with primary nephrotic syndrome（ PNS） and their roles and clinical significance of IL-17 and IL-23 variations in the occurrence and development of PNS. Methods A total of 35 steroid-effective hospitalized patients with PNS and 20 healthy subjects（ healthy control group） were enrolled in the study. The patients with PNS were treated with prednisone according to the conventional dose. T cell subsets from peripheral blood and the levels of IL-17,IL-23 and IL-6 from serum and 24 h urine were detected in healthy control group and the patients with PNS before and after treatment. The correlations of 24 h urinary protein quantification with T cell subsets in peripheral blood and the levels of IL-17,IL-23 and IL-6 in both serum and 24 h urine were analyzed,respectively. Results Compared with healthy control group,the percentage of CD3^＋or CD3^＋CD4^＋cells from patients with PNS significantly decreased（ P〈0. 05）,and the levels of IL-17 and IL-6 from serum as well as IL-17,IL-23 and IL-6 from 24 h urine significantly increased（ P〈0. 05）. After treatment,the percentage of CD3＋or CD3＋CD4＋cells significantly increased（ P〈0. 05）,and the levels of IL-17,IL-23 and IL-6 in 24 h urine significantly decreased（ P〈0. 05）. There were positive correlations between 24 h urinary protein quantification and the levels of IL-17 and IL-23 in both serum and 24 h urine respectively（ P〈0. 01）.Conclusions IL-17 and IL-23 may contribute to the proteinuria of PNS. Hormone therapy can improve the disorder of cell immune function and the imbalance of T cell subsets. Monitoring the levels of IL-17 and IL-23 in serum and 24 h urine may be helpful for disease judgement and clinical therapy.