摘要
目的观察低危及中高危特发性膜性肾病(IMN)患者外周血淋巴细胞亚群间的差异并分析其与24 h尿蛋白定量(24 hUPro)和血清白蛋白(Alb)之间的相关性及接受不同疗法后的变化。方法将150例经临床和肾脏病理确诊为IMN的患者,按随机数字表法分为对照组、观察1组和观察2组,每组50例,每组患者再按照其入组时24 h UPro和Alb基线水平分为低危组(60/150)和中高危组(90/150)2亚组。所有患者均给予常规对症治疗,对照组患者采用改良Ponticelli方案,观察1组患者在对照组治疗基础上同时应用中药肾俞穴敷熨的方法,观察2组患者在对照组治疗基础上同时应用中药俞募配穴敷熨的方法。流式细胞仪测外周血淋巴细胞亚群中CD3+/CD45+、CD3+CD8+/CD45+、CD3+CD4+/CD45+、CD3-CD19+/CD45+、Treg/CD4+及CD4+/CD8+,比较2亚组间上述指标治疗前差异及与24 h UPro和Alb的相关性,及不同疗法对其影响。结果 (1)治疗前中高危组IMN患者较低危组24 h UPro、CD3+CD4+/CD45+、CD3-CD19+/CD45+和CD4+/CD8+明显升高(P<0.05),Alb、CD3+CD8+/CD45+和Treg/CD4+明显下降(P<0.05)。且中高危组IMN患者24 h UPro与CD3+/CD45+、CD3+CD8+/CD45+及Treg/CD4+间均呈负相关(P<0.05),与CD3-CD19+/CD45+及CD4+/CD8+间均呈正相关(P<0.05);而Alb与CD3-CD19+/CD45+及CD4+/CD8+间均呈负相关(P<0.05),与CD3+/CD45+、CD3+CD8+/CD45+及Treg/CD4+间均呈正相关(P<0.05)。(2)2亚组治疗后在24hUPro、CD3+CD4+/CD45+、CD3-CD19+/CD45+和CD4+/CD8+下降及Alb、CD3+CD8+/CD45+和Treg/CD4+提升方面,观察2组效果最优(P>0.05)。结论 (1)中高危组IMN患者较低危组存在明显的淋巴细胞亚群紊乱,且中高危IMN患者淋巴细胞亚群除CD3+CD4+/CD45+外余者均与24 h UPro及Alb之间存在明显的相关性,监测外周血淋巴细胞亚群变化可能有助于指导评估中高危IMN患者治疗;(2)中药俞募配穴敷熨联合改良Ponticelli方案对淋巴细胞亚群紊乱改善疗效最优。
Objective To observe the differences between peripheral blood lymphocyte subsets in patients with low-risk, medium and high-risk idiopathic membranous nephropathy (IMN), and to analyze the correlation between them and 24-hour urinary protein quantification (24 hUPro) and serum albumin (Alb), as well as the changes after receiving different treatments in order to explore its clinical significance. Methods Atotal of 150 patients diagnosed as IMN by clinical and renal pathology were divided into three groups according to the random number table method, control group, observation group 1 and observation group 2, 50 cases in each group, and each group was further divided into two subgroups, low-risk group (60/150) and middle-high risk group (90/150) according to baseline levels of the 24hUPro and Alb. All patients were on the basis of conventional symptomatic supportive treatment, and the control group was treated with modified Ponteticelli. On the basis of the control group, observation group 1 was treated with the method of Traditional Chinese Medicine hot compress the back Shenshu points and observation group 2 were treated with the method of Traditional Chinese Medicine hot compress the back Shenshu and front Jingmen points. Flow cytometry was used to measure CD3^+/CD45^+, CD3^+CD8^+/CD45^+, CD3^+CD4^+/CD45^+, CD3-CD19^+/CD45^+, Treg/CD4^+ and CD4^+/CD8^+ in peripheral blood lymphocyte subsets, and the differences of the above indicators before treatment between the two subgroups was compared, and the correlation with 24 hUPro and Alb, and the changes in the above indicators of the two subgroups after received different therapies were analyzed. Results ①Compared with the low-risk group, 24 hUPro, CD3^+CD4^+/CD45^+, CD3-CD19^+/CD45^+ and CD4^+/CD8^+ were significantly increased in the middle-high risk group of the IMN patients before treatment (P<0.05), Alb, CD3^+CD8^+/CD45^+ and Treg/ CD4^+ decreased signif-icantly (P<0.05). And there was a negative correlation between 24 hUPro and CD3^+/CD45^+, CD3^+CD8^+/CD45^
作者
李俊伟
石伟
蒋莹辉
贾英辉
唐军亭
康锁彬
贺艳光
Li Junwei;Shi Wei;Jiang Yinghui;Jia Yinghui;Tang Junting;Kang Suobin;He Yanguang(Department of Nephrology, Shijiazhuang Kidney Disease Hospital, Hebei 050061, China)
出处
《山西医药杂志》
CAS
2019年第4期413-418,共6页
Shanxi Medical Journal
基金
石家庄市科学技术研究与发展指导计划(171461243)
关键词
肾小球肾炎
膜性
淋巴细胞亚群
T淋巴细胞
调节性
24H尿蛋白定量
Glomerulonephritis, membranous
Lymphocyte subsets
T-lymphocytes, regulatory
24-hour urinary protein quantification
