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