实用医学杂志 ›› 2023, Vol. 39 ›› Issue (4): 436-441.doi: 10.3969/j.issn.1006⁃5725.2023.04.008

• 临床研究 • 上一篇    下一篇

激素敏感型肾病综合征患儿记忆T淋巴细胞亚群精细分型的临床意义 

刘君晗 关凤军 程巾 庄亚飞 石梦月 袁文君 陆书文    

  1. 徐州医科大学附属医院儿科(江苏徐州221002)

  • 出版日期:2023-02-25 发布日期:2023-02-25
  • 通讯作者: 关凤军 E⁃mail:guanxiaomu@sina.com
  • 基金资助:
    国家自然科学基金资助项目(编号:82173630);徐州市科技计划社发重点项目(编号:KC21172)

Clinical significance of memory T lymphocyte subsets in children with steroid sensitive primary nephrotic syndrome

LIU Junhan,GUAN Fengjun,CHENG Jin,ZHUANG Yafei,SHI Mengyue,YUAN Wenjun,LU Shuwen.   

  1. Department of Paediatricsthe Affiliated Hospital of Xuzhou Medical UniversityXuzhou 221002China

  • Online:2023-02-25 Published:2023-02-25
  • Contact: GUAN Fengjun E⁃mail:guanxiaomu@sina.com

摘要:

目的 探讨激素敏感型肾病综合征(steroid⁃sensitivenephroticsyndrome,SSNS)患儿初始糖皮 质激素(glucocorticoid,GC)治疗前后记忆 T 淋巴细胞(memory T cell,TM)亚群精细分型的表达水平及临床意义。方法 选择 35 例初次发病 SSNS 患儿作为研究组,以 20 例健康体检儿童为正常对照组。采用多色 流式细胞术分析比较研究组 GC 治疗前后及对照组 TM 亚群精细分型;酶联免疫吸附法(ELISA)检测各组 T 细胞因子水平,与临床指标做相关性分析。结果 研究组患儿 GC 治疗前 CD4+ TM、CD4+ 中央记忆 T 细胞 central memory T cell,TCM)、CD4+ 效应记忆 T 细胞(effector memory T cell,TEM)、CD8+ TM cell、CD8+ TEM cell 分比(占 CD3+ T 细胞)较缓解期和对照组升高,治疗前 CD4+ 初始 T 细胞(naïve T cell,TN)较缓解期减少,差 异均有统计学意义(P < 0.05),治疗前记忆性干细胞样 T 细胞(stem⁃like memory T cells,TSCM)百分比较缓解 期和对照组升高,差异有统计学意义(P < 0.001);治疗前 T 细胞因子 IL⁃1β、IL⁃8、IFN⁃γ 较缓解期和对照组 升高,差异有统计学意义(P < 0.05);治疗前 CD4+ TEM cell 比例与白蛋白水平、CD4+ TN cell 比例均呈明显负 相关(P < 0.01);与 IFN⁃γ 水平呈正相关(P < 0.05)。结论 SSNS 患儿存在 TM精细功能亚群和 TSCM分布异常,部分 T 细胞因子水平异常且与 TM亚群紊乱密切相关,共同参与疾病的发生发展;GC 治疗干预了 SSNS 患儿TM和TSCM功能亚群的分布,为SSNS 患儿细胞免疫精准治疗提供理论依据。

关键词:

"> 激素敏感型肾病综合征,  , 记忆T淋巴细胞,  , 细胞因子 ,

Abstract:

Objective To investigate the level and clinical significance of fine typing of memory T lymphocyte subsets before and after initial glucocorticoid(GC)treatment in children with steroid ⁃sensitivenephroticsyndrome (SSNS). Methods Thirty⁃five children diagnosed with SSNS for the first time were selected as the research group and twenty healthy children were enrolled as the normal control group. Multicolor flow cytometry was adopted to analyze the fine typing of memory T lymphocyte subsets in children with SSNS before initial treatment and in remission after treatment,and in the control group. Immunosorbent assay(ELISA)was used to detect the level of T⁃cell cytokines ineachgroup,and then the correlation analysis was performed with clinical indexes. Results CD4+ memory T cells(TM),CD4 + central memory T(TCM)cells and CD4 + effector memory T cells(TEM)in the active phase of GC in the SSNS children before initial treatment,CD8+ CD45RO+ TM,CD8+ TEM percentages(% of CD3+ T cells)were higher than those in the remission period and control group after treatment,and the CD4 + naïve T cells(TN)in the active phase were statistically significantly decreased in number compared with those in the remis⁃ sion period(< 0.05),the percentage of stem ⁃like memory T cells(TSCM)in the active phase was significantly higher than that in the remission phase and the control group(< 0.001). Before treatment,the number of T cell cytokines including IL⁃1β,IL⁃8 and IFN⁃γ in the active stage was significantly larger than those in the remission stage and control group(< 0.05)and CD4+ TEM ratio was significantly negatively correlated withalbuminand CD4+ TN ratio(< 0.01)and positively correlated with IFN⁃γ levels(< 0.05). Conclusion Abnormal distribution of TSCM/TM subsets and disturbance of some T cell cytokines were found in SSNS children,and there was a closed relationship between them ,suggesting abnormal TSCM/TM subsets play an important role in the occurrence anddevelopment of the disease;GC application affected the distribution of TM and TSCM functional subsets in children with SSNS.

Key words:

steroid?sensitive nephrotic syndrome, memory T lymphocyte subsets, cytokines