调节性T细胞在不同年龄层次血液透析患者外周血的动态变化分析

Dynamic changes of peripheral blood regulatory T cells in hemodialysis patients of different age

目的分析不同年龄层次慢性肾衰竭(CRF)患者外周血调节性T细胞(Treg)动态变化特点。方法选择我院确诊但未进行血液透析治疗的CRF患者65例,按年龄分为青年组(30~44岁)15例、中年组(45~59岁)27例、老年组(≥60岁)23例,分别于首次透析前及透析治疗1、3个月后采集外周静脉血5mL,同时选择我院正常健康体检者20名,作为对照组,体检当日采集静脉血5 mL,分别监测Treg,T细胞亚群CD3~^+、CD4^+、CD8^+的动态变化,并检查肾功能。结果 1透析前,青年组、中年组、老年组T细胞亚群指标对比差异无统计学意义(P>0.05),但青年组、中年组、老年组CD3^+、CD4^+均低于对照组(P<0.05);透析1个月后,各组CD3^+、CD4^+均上升,以青年组上升幅度最高,与中年组、老年组对比差异有统计学意义(P<0.05)。2透析前,青年组、中年组、老年组Treg指标对比差异无统计学意义(P>0.05);与对照组相比,各组CD4^+CD127-Treg/CD4^+T、CD4^+CD25^+CD127-Treg/CD4^+T细胞均降低(P<0.05);透析后,各组CD4^+CD127-Treg/CD4^+T、CD4^+CD25^+CD127-Treg/CD4^+T细胞均有所上升,以青年组上升幅度最大,与中年组、老年组对比差异均有统计学意义(P<0.05)。3对照组血尿素氮(BUN)、肌酐(Cr)、白细胞计数(WBC)均低于青年组、中年组、老年组(P<0.05);透析后,各组BUN、Cr、WBC指标均降低,青年组BUN、Cr、WBC降低幅度均高于中年组与老年组(P<0.05);中年组透析1个月后BUN、Cr、WBC降低幅度高于老年组(P<0.05)。结论 CRF患者免疫功能降低,血液透析可改善其T细胞免疫,青年、中年、老年CRF患者中,以青年组血液透析后免疫及肾功能指标改善最显著。

Objective To analyze the features of dynamic changes of peripheral blood regulatory T cells（Treg）in patients with chronic renal failure（CRF）of different age.Methods Sixty-five cases of patients,who were diagnosed with CRF and not treated with hemodialysis in our hospital,were selected and were divided into young group（30-44 years old,n=15）,middle-aged group（45-59 years old,n=27）and aged group（≥60years old,n=23）.Peripheral venous blood（5mL）of the three groups were respectively collected before hemodialysis,after 1month and 3months of hemodialysis.Meanwhile,20 cases of healthy people in our hospital were included in the control group.On the day of physical examination,venous blood（5mL）was collected and the dynamic changes of Treg,T lymphocyte subsets CD3~＋,CD4~＋and CD8~＋were monitored.Renal function was examined.Results 1Before dialysis,there was no significant difference in T lymphocyte subsets among the young group,middle aged group and aged group（P〈0.05）.CD3~＋and CD4~＋in the young group,middle age group and aged group were lower than those in the control group（P〈0.05）;After 1months of dialysis,CD3~＋and CD4~＋in the groups increased and the increasing range in the young group was the highest.Compared with that in the middle aged group and aged group,there was significant difference（P〈0.05）.2Before dialysis,there was no difference in T cell indexes among the young group,middle aged group and aged group（P〈0.05）;Compared with those in the control group,CD4~＋CD127-Treg/CD4~＋T and CD4~＋CD25~＋CD127-Treg/CD4~＋T in other groups decreased（P〈0.05）;after dialysis,CD4~＋CD127-Treg/CD4~＋T and CD4~＋CD25~＋CD127-Treg/CD4~＋T in the groups increased,and the increasing range in the young group was the highest.Compared with that those in the middle aged group and aged group,there was significant difference（P〈0.05）.3Blood urea nitrogen（BUN）,creatinine（Cr）and white blood cell count（WBC）in the control group were lower than those in the young group,middle age group and aged group（P〈0.05）;after dialysis,BUN,Cr and WBC indexes decreased in the groups.The decreasing ranges of BUN,Cr and WBC in young group were significantly greater than those in middle age group and aged group（P〈0.05）;after 1months of dialysis,the decreasing ranges of BUN,Cr and WBC in the middle aged group were lower than those in the aged group（P〈0.05）.Conclusion The immune function in patients with chronic renal failure decreases.Hemodialysis can improve the T cell immunity.Among youth,middle-aged and aged patients with CRF,the improvement of immuneity and renal function in young patients is the most significant.