中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (05): 318-321.doi: 10.3969/j.issn.1671-4091.2017.05.009

• 临床研究 • 上一篇    下一篇

终末期肾脏病患者与成年健康个体免疫功能的比较

魏媛媛1,马迎春2,祝小东3,张莉4,王欣欣4   

  1. 首都医科大学康复医学院，中国康复研究中心北京博爱医院肾内科
  • 收稿日期:2016-12-12 修回日期:2017-03-27 出版日期:2017-05-12 发布日期:2017-05-19
  • 通讯作者: 马迎春 mych323@163.com E-mail:weiyy1116@163.com
  • 基金资助:

    中央级公益性科研院所基本科研业务费专项资金2015ZX-19

Comparison of immune function between end-stage renal disease patients and healthy adults

  • Received:2016-12-12 Revised:2017-03-27 Online:2017-05-12 Published:2017-05-19

PDF

413

摘要： 目的比较终末期肾脏病(end-stage renal disease，ESRD)患者与健康成人的免疫功能指标的差异，探讨ESRD 患者免疫功能障碍的机制。方法选择于2016 年1～6 月在中国康复研究中心北京博爱医院肾内科就诊的ESRD 患者，选择健康成年个体作为对照。比较ESRD 患者和成年健康个体固有免疫和获得性免疫功能指标的水平，固有免疫指标包括全血白细胞、中性粒细胞、嗜酸性粒细胞、嗜碱性粒细胞、自然杀伤(natural killer，NK)细胞计数、NK 细胞百分比、血清补体C3、血清补体C4；获得性免疫指标包括：全血淋巴细胞计数和百分比、CD4+T 淋巴细胞计数、CD8+T 淋巴细胞计数及CD4/CD8 比值。结果共入组ESRD 患者40 例，平均年龄(56.8±12.0)岁，对照组18 例，平均年龄(51.3±12.4)岁。固有免疫指标方面：ESRD 患者全血白细胞总数(F=2.130，t=-2.008，P=0.049)、中性粒细胞计数(F=4.587，t=-3.997，P＜0.001)、中性粒细胞比例(F=0.685，t=-3.726，P＜0.001)、血清补体C4 水平(F=0.018，t=-2.800，P=0.007)均高于健康成年个体，差异有统计学意义。全血NK 细胞计数(F=0.864，t=2.034，P=0.011)和血清补体C3 水平(F=0.425，t=3.181，P=0.002)均低于健康成年个体，差异有统计学意义。获得性免疫指标方面：ESRD 患者全血淋巴细胞总数(F=0.274，t=5.419，P＜0.001)及淋巴细胞百分比(F=0.164，t=8.528，P＜0.001)均显著低于健康成年个体，分别为(1.32±0.39)×109/L 比(1.94±0.43)×109/L，(21.39±5.73)%比(35.53±6.10)%，差异具有统计学意义；ESRD 患者CD4+T 淋巴细胞计数显著低于健康个体，分别为(733.10±298.76)个/UL 比(915.88±289.05)个/UL，F=0.903，t=2.160，P=0.035，差异具有统计学意义。结论ESRD 患者存在固有免疫和获得性免疫功能障碍，这种免疫功能障碍可能与全血白细胞总数、中性粒细胞计数及比例增高，全血NK 细胞计数、淋巴细胞计数及比例、CD4+T 淋巴细胞计数降低及血清补体C3水平降低等因素有关。

关键词: 终末期肾脏病, 固有免疫, 获得性免疫, 感染

Abstract: Objective To compare immune function between end-stage renal disease (ESRD) patients and healthy adults in order to explore the mechanism of abnormal immune function in ESRD patients. Methods ESRD patients from Department of Nephrology, Beijing Boai Hospital, China Rehabilitation Research Center during Jan to Jun. 2016 were enrolled in this study, and healthy adults were used as the controls. Innate immune and acquired immune functions were evaluated in ESRD patients and controls. Innate immune functions included counts of blood leukocytes, neutrophils, eosinophils, basophils and natural killer (NK), percentage of NK cells, and serum C3 and C4. Acquired immune functions included count and percentage of lymphocytes, CD4+ and CD8+ lymphocyte counts, CD4+/CD8+ cell ratio. Results A total of 40 ESRD patients [mean age (56.8±12.0) years] and 18 heathy adults [mean age (51.3±12.4) years] were enrolled in this study. For innate immune parameters, white blood cell count (F=2.130, t=2.008. P=0.049), neutrophil count (F=4.587, t= -3.997, P<0.001), neutrophil percentage (F=0.685, t=-3.726, P<0.001) and the serum C4 (F=0.425, t=3.181, P=0.002) were higher in ESRD patients than in healthy adults; NK cell count (F =0.864, t =2.034, P=0.011) and serum C3 (F=0.425, t=3.181, P=0.002) were lower in ESRD patients than in healthy adults. For acquired immune parameters, blood lymphocyte count [(1.32±0.39)×109/L vs. (1.94±0.43)×109/L; F=0.274, t =5.419, P <0.001], blood lymphocyte percentage [(21.39±5.73)% vs. (35.53± 6.10)%; F=0.164, t=8.528, P<0.001], and CD4+ T lymphocyte count [(733.10±298.76)/UL vs. (915.88±289.05)/UL; F=0.903, t=2.160, P=0.035] were significantly lower in ESRD patients than in healthy adults. Conclusion Abnormal innate and acquired immune functions existed in ESRD patients. The abnormal immune functions presented as the increase of white blood cell count, neutrophil count and neutrophil percentage, and the decrease of NK cell count, lymphocyte count, lymphocyte percentage, CD4+ T lymphocyte count, and serum C3 level.

Key words: End-stage renal disease, Innate immune, Acquired immune, Infection