中国血液净化

›› 2011, Vol. 10 ›› Issue (4): 189-193.doi: 10.3969/j.issn.1671-4091.2011.04.00

• 临床研究 • 上一篇    下一篇

终末期肾病患者的获得性免疫缺陷和甲状旁腺激素水平的关系

王海云 陈丽萌 李雪梅 邱志峰 陶建瓴 邱 玲 徐 红 周紫鹃 李太生 李学旺   

  1. 中国医学科学院 北京协和医学院 北京协和医院
  • 收稿日期:2010-11-04 修回日期:1900-01-01 出版日期:2011-04-12 发布日期:2011-04-12
  • 通讯作者: 李雪梅

Relationship between acquired immune disturbances and parathyroid hormone levels in end stage renal disease patients

WANG Hai-yun, CHEN Li-meng, LI Xue-mei, QIU Zhi-feng, TAO Jian-ling, QIU Ling, XU hong, ZHOU Zi-juan, LI Tai-sheng, LI Xue-wang   

  1. Kidney Department, Infection Disease Department, Department of Laboratory Medicine, Peking Union Medical College Hospital, Beijing 100730, China
  • Received:2010-11-04 Revised:1900-01-01 Online:2011-04-12 Published:2011-04-12

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摘要： 目的 淋巴细胞功能改变与尿毒症毒素如甲状旁腺激素(parathyroid hormone,PTH)之间的关系并不清楚，观察维持性血液透析的终末期肾脏病(end-stage renal disease,ESRD)患者的B和T细胞亚群分型，评价T细胞功能与血浆PTH之间的相关性。 方法 检测接受血液透析和腹膜透析的257例ESRD患者血常规淋巴细胞计数，根据患者是否血液透析和血PTH水平将患者分为3组：非透析的慢性肾脏病(chronic kidney disease,CKD)患者(20例)，PTH≥300 pg/ml的稳定的血液透析患者(12例)和PTH＜300 pg/ml的稳定的血液透析患者(11例)。同时用单克隆抗体流式细胞术检测T、B细胞亚群比例和绝对值，分析维持性血液透析患者PTH水平与T细胞亚群之间的关系。用SPSS 10.0软件包进行非配对t检验和秩和检验，相关分析用Pearson相关分析。 结果 尽管257例患者中仅3.9%的患者观察到白细胞降低，但47.5%(122/257)的ESRD患者有淋巴细胞比例降低。血液透析患者与非透析的CKD患者相比，淋巴细胞数降低，分别为(1367.4±650.4)和(1942.3±856.3)，差异有统计学意义(P＜0.05)；B(CD19+)淋巴细胞数降低，分别为(114.0±88.2)和(229.3±143.3)，差异有统计学意义(P＜0.001)；T淋巴细胞(CD3+)数降低，分别为(1035.9±497.4)和(1483.4±674.1)，差异有统计学意义(P＜0.05)；不论是T辅助(CD4+)细胞还是T抑制、细胞毒(CD8+)细胞中，CD28+细胞比例和绝对值均降低。维持性血液透析的ESRD患者低PTH组B细胞(CD19+)比例[(4.9±2.0) vs (9.8±4.5%), P =0.014]和绝对值[(68.5±41.4) vs (156.6±96.3), P =0.036]更低。 结论 规律血液透析的尿毒症患者的存在T、B淋巴细胞免疫功能异常，PTH的浓度差异可能和B细胞功能相关。

关键词: 血液净化, 淋巴细胞亚群, 甲状旁腺激素

Abstract: 【Abstract】 Objective The clinical relevance of altered lymphocyte function to uremic toxins, such as higher parathyroid hormone (PTH), is not well understood. We studied the changes of B- and T-cellular immunity in end stage renal disease (ESRD) patients with hemodialysis (HD), and evaluated the relationship between T-lymphocyte function and plasma PTH level. Methods Blood cell analysis was conducted in 257 ESRD patients. Patients were divided into 3 groups based on treatment and PTH level: chronic kidney disease (CKD) patients without dialysis (n=20), HD patients with higher PTH (>300pg/ml, n=12), and HD patients with lower PTH (<300 pg/ml, n=11). Lymphocyte subsets were quantified in the 3 groups using monoclonal antibodies and flow cytometry. Analysis of variance (ANOVA) and Pearson correlation analysis using SPSS version 10.0 were performed to test the differences between the 3 groups. Results (a) The percentage of Lymphocytes decreased in 47.5% (122/257) ESRD patients, but the white blood cell count decreased in only 3.9% of the 257 patients. (b) When comparisons were made between ESRD patients with HD and CKD patients without HD, lymphocyte count (1367.4±650.4 vs. 1942.3±856.3, P<0.05), CD19+ B-cells (114.0±88.2 vs. 229.3±143.3, p<0.001), and CD3+ T-cells (1035.9±497.4 vs. 1483.4±674.1, P<0.05) were lower in ESRD patients with HD, in association with the lower percentage and cell count of CD4+ T-cells, CD8+ T-cells and CD28+ cells. (c) CD19+ cells decreased significantly in HD patients with lower PTH (<300 pg/ml). Conclusion T-cell and B-cell functions are abnormal in ESRD patients with HD. Serum PTH level may affect B-cell function.

Key words: Lymphocyte subgroup, PTH

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