摘要
目的观察原发性肾病综合征(PNS)患儿泼尼松治疗前后CD4+CD25+调节性T细胞(CD4+CD25+Tr)的变化,阐明肾上腺糖皮质激素治疗儿童PNS的免疫机制。方法选择2004—2007年在深圳市儿童医院住院治疗的初发PNS患儿42例,其中激素敏感型32例,激素耐药型10例。同期25例健康体检儿童作为对照组。流式细胞术检测泼尼松治疗前后外周血CD3+CD4+CD8-、CD3+CD4-CD8+、CD4+CD25+Tr的比例,荧光定量聚合酶链反应(Real-timePCR)检测泼尼松治疗前后外周血单个核细胞(PBMC)叉头型基因P3(Foxp3)、细胞毒性T淋巴细胞相关抗原4(CTLA-4)和糖皮质激素诱导的肿瘤坏死因子受体(GITR)基因mRNA的表达。结果与对照组比较,PNS患儿外周血CD3+CD4+CD8-T细胞、CD3+CD4-CD8+T细胞、CD4+CD25+Tr比例无明显改变(P>0.05)。激素敏感型PNS患儿CD4+CD25+Tr比例在泼尼松治疗后明显增高,差异有统计学意义(P<0.01);激素耐药型PNS患儿CD4+CD25+Tr比例在泼尼松治疗前后无明显改变(P>0.05)。激素敏感型PNS患儿在泼尼松治疗后PBMC细胞Foxp3、CTLA-4和GITR基因mRNA的表达明显增高;而激素耐药型PNS患儿泼尼松治疗前后Foxp3、CTLA-4基因表达无明显改变,仅GITR表达明显增高。结论泼尼松等肾上腺糖皮质激素类药物可通过上调激素敏感型PNS患儿CD4+CD25+调节性T细胞的表达发挥免疫治疗作用。
Objective To study the changes of CD4^＋CD25^＋ Tr in primary nephrotic syndrome before and after treatment with prednisone.To explore the immuno-pathogenesis in children with primary nephrotic syndrome. Methods A total of 42 patients with PNS in Shenzhen Children＇s Hospital from 2004 to 2007 were divided into the steroid-responsive group （32 cases） and the steroid-resistant group （10 cases）, and 20 age-matched healthy subjects were studied. Before and after treatment , flow cytometric analysis （FCM） was performed to detect the percentage of T cells subpopulation （including CD3^＋CD4^＋CD8^-, CD3^＋CD4^-CD8^＋,CD4^＋CD25^＋Tr） ; real-time PCR was used to detect Foxp3 , CTLA-4 and GITR mRNA expression in peripheral blood mononuclear cell （PBMC）.Results Compared with healthy control subjects , the percentage of CD3^＋CD4^＋CD8^- T cell , CD3^＋CD4^-CD8^＋ T cell and CD4^＋CD25^＋ Tr cell in patients with PNS had no change. The percentage of CD4^＋CD25^＋Tr of the steroid-responsive group was significantly higher after treatment with prednisone than before （P 〈 0.01）. The percentage of CD4^＋CD25^＋Tr of steroid-resistant group had no change before and after treatment（P 〉 0.05）. At the same time, after treatment , the Foxp3 , CTLA-4 and GITR mRNA expression in PBMC were significantly higher in the steroid-responsive group, while in the steroid-resistant group the Foxp3 , CTLA-4 mRNA expression had no change, and only GITR mRNA expression was significantly higher. Conclusion The glucocoticoid drugs （including prednisone） might perform immunotherapy effect through upregulating CD4^＋CD25^＋ Tr gene expression in steroid-responsive children with PNS.
出处
《中国实用儿科杂志》
CSCD
北大核心
2009年第5期369-371,共3页
Chinese Journal of Practical Pediatrics
基金
深圳市科技项目编号(200602082)
作者简介
电子信箱：yymmxx@gmail．com
