中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (11): 833-838.doi: 10.3969/j.issn.1671-4091.2024.11.007

• 临床研究 • 上一篇    下一篇

维持性血液透析患者外周血γδT细胞CC趋化因子受体5 mRNA表达与预后的相关性

李小丽    朱 江    王栖栖     张庆娟    袁自静   

  1. 211100 南京，1南京医科大学附属江宁医院肾内科
  • 收稿日期:2024-03-26 修回日期:2024-08-06 出版日期:2024-11-12 发布日期:2024-11-12
  • 通讯作者: 朱江 E-mail:zj1118z@163.com
  • 基金资助:
    江苏省卫生健康委科研项目(H2021016)

The relationship between the expression CCR5 mRNA in peripheral blood gamma delta T cells and the prognosis of maintenance hemodialysis patients

LI Xiao-li, ZHU Jiang, WANG Qi-qi, ZHANG Qing-juan, YUAN Zi-jing   

  1. Department of Nephrology, Jiangning Hospital Affiliated to Nanjing Medical University, Nanjing 211100, China
  • Received:2024-03-26 Revised:2024-08-06 Online:2024-11-12 Published:2024-11-12
  • Contact: 211100 南京，1南京医科大学附属江宁医院肾内科 E-mail:zj1118z@163.com

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摘要： 目的  探讨维持性血液透析(maintenance hemodialysis，MHD)患者外周血γδT细胞中CC趋化因子受体5(CC chemokine receptor 5，CCR5)信使核RNA(messenger ribonucleic acid，mRNA)表达与预后的关系。 方法  选取2018年1月─2020年12月在南京医科大学附属江宁医院接受MHD治疗的191例患者(MHD组)、体检健康者109例(对照组)。检测受试者实验室指标和外周血γδT细胞CCR5 mRNA表达。随访3年将MHD患者分为生存组160例和死亡组31例。分析CCR5 mRNA与年龄、透析龄、血红蛋白(Hb)、白蛋白(ALB)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF)-α的相关性，影响MHD患者3年内生存的因素，CCR5 mRNA对MHD患者3年内生存的预测价值。 结果  MHD组Hb、ALB、血钙低于对照组    (t=10.172、4.702、7.702，P均＜0.001)，血磷、血肌酐、血尿素氮、全段甲状旁腺激素、hs-CRP、TNF-α、CCR5 mRNA高于对照组(t=20.196、77.626、52.291、80.126、42.637、46.766、57.854，P均＜0.001)；与生存组比较，死亡组年龄、透析龄、hs-CRP、TNF-α、CCR5 mRNA升高(t=4.525、13.841、14.991、20.662、54.229，均P＜0.001)，Hb、ALB降低(t=8.783、15.190，均P＜0.001)；MHD患者CCR5 mRNA与年龄、透析龄、hs-CRP、TNF-α呈正相关(r=0.448、0.463、0.567、0.405，均P＜0.001)，与Hb、ALB呈负相关(r=-0.502、-0.491，均P＜0.001)；年龄(HR=2.250，95% CI：1.228～4.123，P=0.009)、透析龄(HR=3.196，95% CI:1.454～7.028，P=0.004)、hs-CRP(HR=3.717，95% CI:1.876～7.367，P＜0.001)、TNF-α(HR=2.497，95% CI:1.193～5.227，P=0.015)、CCR5 mRNA(HR=2.358，95%CI:1.439～3.865，P=0.001)是MHD患者3年内生存的独立危险因素，Hb(HR =0.401，95% CI:0.204～0.787，P=0.008)、ALB(HR=0.456，95% CI:0.241～0.862， P=0.016)是独立保护因素；CCR5 mRNA预测MHD患者3年内生存的AUC为0.927，敏感度85.71%，特异度93.96%。 结论  MHD患者外周血γδT细胞CCR5 mRNA呈高表达，CCR5 mRNA对MHD患者3年内生存有一定预测效能。

关键词: 维持性血液透析, 外周血γδT细胞, CC趋化因子受体5, 预测效能

Abstract: Objective   To investigate the relationship between the expression of CC chemokine receptor 5 (CCR5) mRNA in peripheral γδ T cells and the prognosis of maintenance hemodialysis (MHD) patients.  Methods  A total of 191 MHD patients (MHD group) and a total of 109 healthy subjects (control group) in Jiangning Hospital Affiliated to Nanjing Medical University in the period from January 2018 to December 2020 were recruited in this study. Laboratory indexes and CCR5 mRNA expression in peripheral γδ T cells were examined. After 3 years of follow-up, the MHD patients were divided into survival group (n=160) and death group (n=31). The correlation of CCR5 mRNA in peripheral γδ T cells with age, dialysis age, hemoglobin (Hb), albumin (ALB), hypersensitive C-reactive protein (hs-CRP) and tumor necrosis factor (TNF)-α were analyzed. The factors affecting the 3-year survival of MHD patients, and the predictive value of CCR5 mRNA in peripheral γδ T cells for 3-year survival in MHD patients were evaluated.  Results  Compared with control group, Hb, ALB and blood calcium decreased significantly (t=10.172, 4.702 and 7.702 respectively; P<0.001), while blood phosphorus, serum creatinine, blood urea nitrogen, intact parathyroid hormone, hs-CRP, TNF-α and CCR5 mRNA in peripheral γδ T cells increased significantly (t=20.196, 77.626, 52.291, 80.126, 42.637, 46.766 and 57.854 respectively; P<0.001) in MHD group. In death group, age, dialysis age, hs-CRP, TNF-α, CCR5 mRNA in peripheral γδ T cells increased significantly (t=4.525, 13.841, 14.991, 20.662 and 54.229 respectively; P<0.001), while Hb and ALB decreased significantly (t=8.783 and 15.190; P<0.001), as compared those in survival group. In MHD patients, CCR5 mRNA in peripheral γδ T cells was positively correlated with age, dialysis age, hs-CRP and TNF-α (r=0.448, 0.463, 0.567 and 0.405 respectively; P<0.001), and negatively correlated with Hb and ALB (r=-0.502 and -0.491; P<0.001). Age (HR=2.250, 95% CI: 1.228～4.123, P=0.009), dialysis age (HR=3.196, 95% CI: 1.454～7.028, P=0.004), hs-CRP (HR=3.717, 95% CI: 1.876～7.367, P<0.001), TNF-α (HR=2.497, 95% CI: 1.193～5.227, P=0.015) and CCR5 mRNA in peripheral γδ T cells (HR=2.358, 95% CI: 1.439～3.865, P=0.001) were the independent risk factors, while Hb (HR=0.401, 95% CI: 0.204～0.787, P=0.008) and ALB (HR=0.456, 95% CI: 0.241～0.862, P=0.016) were the independent protective factors for 3-year survival in MHD patients. The area under curve of CCR5 mRNA in peripheral γδ T cells for predicting 3-year survival in MHD patients was 0.927, with the sensitivity of 85.71% and the specificity of 93.96%.  Conclusions The expression of CCR5 mRNA in peripheral blood γδT cells is higher in MHD patients, and has a predictive value for 3-year survival in MHD patients.

Key words: Maintenance hemodialysis, Peripheral blood γδT cells, CC chemokine receptor 5; , Predictive effectiveness

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