摘要
目的探讨特发性膜性肾病患者外周血Th17和调节性T细胞在环孢素A治疗前后的变化及其与疗效的关系。方法选择我院2015-09~2016-10期间确诊为特发性膜性肾病且危险程度分级为中高危患者24例作为观察组,12例健康志愿者作为健康组,所有观察组均予以醋酸泼尼酸联合环孢素A治疗,随访6个月,根据疗效分为有效组及无效组。采用全自动生化法检测患者血清ALB、24 h尿蛋白,采用流式细胞仪检测外周血Th17、Treg百分比,ELISA检测外周血IL-17、TNF-α和TGF-β1水平。结果与健康对照组相比,观察组外周血Th17百分比和IL-17、TNF-α水平升高(P<0.05),而外周血Treg百分比及TGF-β1水平降低(P<0.05),其中高危组患者外周血Th17百分比、IL-17及TNF-α明显高于中危组,而外周血Treg百分比及TGF-β1明显低于中危组;线性相关分析提示观察组24 h尿蛋白水平与Th17百分比成正相关,与Treg百分比水平成负相关,与Th17/Treg比值成正相关。经规范氢化泼尼松联合环孢素A治疗6月后,根据血清白蛋白水平及24 h尿蛋白水平将观察组分为有效组与无效组,其中有效组患者不仅24 h尿蛋白定量下降,而且外周血Th17百分比和IL-17、TNF-α水平下降(P<0.05),外周血Treg百分比及TGF-β1升高(P<0.05),而无效组上述改变不明显(P>0.05)。结论特发性膜性肾病患者存在外周血Th17/Treg失衡,并且可能与病情严重程度相关;环孢素A治疗特发性膜性肾病可有效改善外周血Th17/Treg免疫失衡,其失衡改善程度与环孢素A疗效相关;监测特发性膜性肾病患者外周血Treg、Th17含量变化对指导病情评估及临床治疗疗效有重要意义。
Objective To investigate the changes of peripheral blood Th17 and Treg in patients with idiopathic membranous nephropathy before and after cyclosporine A treatment and its correlation with the efficiency. Methods Twenty-four middle-and high-risk patients with idiopathic membranous nephropathy were enrolled as IMN group in our hospital from September 2015 to October 2016.Twelve healthy subjects were selected as healthy group. All patients were treated with prednisone combined with cyclosporine A for 6 months. All patients were divided into effective group and ineffective group according to the albumin and 24 h urine protein after 6-month treatment. The automatic biochemical methods were used to detect the serum albumin and 24 h urine protein,and flow cytometry was used to detect the peripheral blood Th17 percentage and Treg percentage,and ELISA was used to detect the levels of peripheral blood IL-17,TNF-α and TGF-β1. Results Compared with healthy controls,the levels of IL-17 and TNF-α and Th17 percentage in peripheral blood were increased in patients with idiopathic membranous nephropathy（ P〈0. 05）,while the level of TGF-β1 and Th17 percentage in peripheral blood were decreased（ P〈0. 05）. The peripheral blood Th17 percentage was significantly higher in high-risk group than in middle-risk group and healthy group（ P〈0. 05）,while the peripheral blood Treg percentage was significantly lower（ P〈0. 05）,the IL-17 level was significantly higher in middle-risk group than in healthy group（ P〈0. 05）,the Treg percentage was significantly lower in middle-risk group than in healthy group（ P〈0. 05）. The 24 h urine protein level was positively correlated with Th17 and Th17/Treg ratio,but negatively correlated with Treg level. After cyclosporine A treatment for 6 months,the levels of IL-17 and TNF-α and Th17 percentage in peripheral blood were decreased in effective group（ P〈0. 05）,and the percentage of Treg in peripheral blood and TGF-β1 level increased（ P〈0. 05）,while the above-mentioned changes were not significant in ineffective group. Conclusion Patients with idiopathic membranous nephropathy have an imbalance of Th17/Treg in the peripheral blood and may be related to the severity of the disease. Cyclosporine A can effectively improve the immune imbalance of Th17/Treg in peripheral blood in the patients with idiopathic membranous nephropathy,and the efficacy of cyclosporine A is related to the severity of disease. Monitoring the changes of Treg and Th17 percentages in peripheral blood of patients with idiopathic membranous nephropathy is of great significance to the assessment of the disease and clinical efficiency.
作者
唐丹
张剑彬
郭继光
陈莉
段雪莲
TANG Dan;ZHANG Jianbin;GUO Jiguang;CHEN Li;DUAN Xuelian(Department ofNephrology, Yongchuan Hospital, Chongqing Medical University, Yongchuan District, Chongqing 402160, China)
出处
《山西医科大学学报》
CAS
2018年第5期556-561,共6页
Journal of Shanxi Medical University
作者简介
唐丹，女，1992-02生，硕士，E-mail：617547270@qq．com;通讯作者，E-mail：906062731@qq．com
