ICOS^+/PD-1^+滤泡辅助性T细胞比值在特发性膜性肾病疾病进展的临床意义

The clinical significance of the ratio of ICOS^+/PD-1^+Tfh cells in the development of idiopathic membranous nephropathy

目的研究滤泡辅助性T细胞(Tfh)及其亚群ICOS+Tfh和PD-1+Tfh在特发性膜性肾病(IMN)患者外周血中所占比例,并揭示ICOS+/PD-1+Tfh比值对于提示IMN疾病进展的临床意义。方法依据24h尿蛋白量将IMN患者分为A组(<4g)、B组(4-8g)和C组(>8g),外周血中不同Tfh细胞亚群所占比例利用流式细胞术分析,胞外血清中IL-21的含量利用ELISA试剂盒检测。结果与健康对照组(HC)比较,外周血中Tfh、ICOS+Tfh和PD-1+Tfh的比例在B组中明显升高,在C组中下降,但C组中ICOS+/PD-1+Tfh比值却明显高于其他患者组和HC组。IL-21+Tfh在C组中的比例高于其他患者组和HC组,但在A组和B组间无明显差异。血清中IL-21在IMN患者血清中的含量也明显高于HC组,在患者组之间没有差异。ICOS+/PD-1+Tfh比值与IMN患者24h尿蛋白量呈正相关。结论ICOS+/PD-1+Tfh比值可能作为评估IMN疾病进展的一个新指标。

Objective To explore the frequency of Tfh and its subsets ICOS^+Tfh and PD-1^+Tfh in peripheral blood of patients with IMN,and illustrate the clinical significance of the ratio of ICOS^+/PD-1^+Tfh in suggesting disease progression.Methods According to 24 hurine protein,IMN patients were divided into group A(<4 g),group B(4-8 g)and group C(>8 g).The frequency of different Tfh subsets in peripheral blood were analyzed by flow cytometry,and the concentration of IL-21 in serum was tested by ELISA kit.Results Compared with HC,the frequency of Tfh,ICOS^+Tfh and PD-1^+Tfh was increased in group B,but decreased in group C.But however,the ratio of ICOS^+/PD-1^+Tfh in group C was obviously higher than that in other patient groups and HC.The frequency of IL-21^+Tfh was higher in group C than in other patient groups and HC,but had no difference in patient groups.Though the extracellular level of IL-21 was also higher in the serum of patients with IMN than in HC group,but there was no significant difference in patient groups.The ratio of ICOS^+/PD-1^+Tfh was positively correlated with 24 hurine protein.Conclusion The ratio of ICOS^+/PD-1^+Tfh may be a new indicator to assess the disease development of IMN.