肾综合征出血热患者sIL-2R和淋巴细胞亚群的变化

Dynamic changes of soluble interleukin-2 receptor and lymphocyte subsets in patients with hemorrhagic fever with renal syndrome

目的 研究肾综合征出血热 (HFRS)患者各病期sIL 2R水平和淋巴细胞亚群百分比的动态变化和二者间关系以及与肾脏损伤的关系 ,以探讨细胞免疫功能紊乱在HFRS发病机制中的作用。方法 采用双抗体夹心ELISA法对 3 0例HFRS患者血清sIL 2R水平进行检测。应用流式细胞仪检测 3 9例HFRS患者的 95份外周血的淋巴细胞亚群百分比。结果 HFRS患者在发热期sIL 2R水平即已明显升高 ,低血压少尿期达高峰 ,多尿期开始逐渐下降 ,至恢复期仍处于较高水平 (P <0 .0 1)。HFRS患者各病期T细胞 (CD3 + )百分比无变化。但在发热期CD3 + ,CD4+ 细胞百分比已明显减少 ,CD3 + ,CD8+ 细胞百分比明显增多 ,导致CD4+ /CD8+ 比值下降、倒置 ;低血压少尿期达极值(P <0 .0 1) ,多尿期开始逐渐恢复 ,但至恢复期仍未恢复正常水平 (P <0 .0 5 )。HFRS患者在发热期和低血压少尿期自然杀伤 (NK)细胞 (CD16+ ,CD5 6+ )百分比下降 ,而B细胞 (CD19+ )百分比升高 ,多尿期开始逐渐恢复至正常水平。并且sIL 2R水平与CD3 + ,CD4+ 细胞百分比呈负相关 (P <0 .0 1) ,与CD3 + ,CD8+ 细胞百分比呈正相关 (P <0 .0 5 ) ,与CD4+ /CD8+ 比值呈负相关 (P <0 .0 1)。sIL 2R水平与尿素氮、肌酐成正相关 (均P <0 .0 1) ,CD4+ /CD8+ 比值与尿素氮。

Objective To study the dynamic changes of soluble interleukin 2 recepter (sIL 2R) level and lymphocyte subsets over clinical course, the relationship between them and biochemical parameters of renal function, and to explore the role of the disturbance of celluar immune function in the pathogenesis of hemorrhagic fever with renal syndrome (HFRS). Methods The level of sIL 2R in sera was detected by double antibody sandwich ELISA method. The percentages of lymphocyte subsets were measured by flow cytometry. Results The level of sIL 2R in patients with HFRS increased significantly in febrile phase, reached its peak in hypotensive and oliguric phase and then decreased gradually in diuretic phase but still higher than that of normal in convalescent phase with values being (463.06±157.02) pmol/ml, (636.85±270.36) pmol/ml, (287.75±118.74) pmol/ml and (191.75±55.60) pmol/ml in different stages, respectively ( P <0.01). There were no change in the percentages of T cells (CD3 +) among different phases ( P >0.05). The percentage of CD3 +,CD4 + cells decreased significantly while the percentage of CD3 +, CD8 + cells increased significantly, which resulted in the decrease or reverse of CD4 +/CD8 + ratio in febrile phase. These changes were most obvious in hypotensive and oliguric phase, returned gradually in diuretic phase, but still abnormal in convalescent phase ( P <0.05). The percentage of B cells (CD19 +) increased while the percentage of NK cells (CD16 +,CD56 +) decreased in febrile, hypotensive, and oliguric phase, returned gradually in diuretic, reached normal in convalescent phase. There existed a negative correlation between the level of sIL 2R and the percentage of CD3 +,CD4 + cells ( P <0.01), a positive correlation between the level of sIL 2R and the percentage of CD3 +,CD8 + cells ( P <0.05), and a negative correlation between the level of sIL 2R and the CD4 +/CD8 + ratio ( P <0.01). A positive correlation was observed between the level of sIL 2R and blood urea nitrogen (BUN), creatinine (Cr) ( P <0.01), with the pre sence of negative correlation between the CD4 +/CD8 + ratio and BUN, Cr ( P <0.01, P <0.05). Conclusions The disturbance of celluar immune function may play an important role in the pathogenesis of HFRS. Celluar immune function remains to be abnormal in convalescent phase. Attentions should be paid clinically to the patients in convalescent phase.