特发性膜性肾病患者血清CTLA-4 水平 及其临床意义

level of Serum CTLA-4 in patients with idiopathic membranous nephropathy and its clinical significance

摘要:

目的 探讨特发性膜性肾病患者血清细胞毒性T 淋巴细胞抗原4（CTLA-4）水平及其临床 意义。方法 选择特发性膜性肾病患者80 例作为膜性肾病组，同期80 例健康体检者作为对照组。收集两 组临床资料，测定外周血调节性T 细胞数量和血清可溶性细胞毒性T 细胞相关抗原4（sCTLA-4）水平。 结果 膜性肾病组患者血清白蛋白、调节性细胞计数及sCTLA-4 水平均低于对照组（P <0.05）；而血肌酐（Scr） 和24 h 尿蛋白量高于对照组（P <0.05）。膜性肾病中高危组患者血清白蛋白、调节性细胞计数及sCTLA-4 水平均低于低危组（P <0.05）；而Scr 和24 h 尿蛋白量高于低危组（P <0.05）。膜性肾病患者治疗后血清白蛋白、 调节性细胞计数及sCTLA-4 水平高于治疗前（P <0.05）；而Scr 和24 h 尿蛋白量低于治疗前（P <0.05）。与 无效比较，部分缓解和完全缓解患者血清白蛋白、调节性细胞计数及sCTLA-4 水平升高（P <0.05）；而Scr 和24 h 尿蛋白量降低（P <0.05）。与部分缓解比较，完全缓解患者血清白蛋白、调节性细胞计数和sCTLA-4 水平升高（P <0.05）；而Scr 和24 h 尿蛋白量降低（P <0.05）。膜性肾病患者sCTLA-4 水平与血清白蛋白、 调节性细胞呈正相关（P <0.05）；与Scr、24 h 尿蛋白量呈负相关（P <0.05）。结论 特发性膜性肾病患者血 清sCTLA-4 降低，血清sCTLA-4 水平可反映特发性膜性肾病患者机体免疫状态、疾病严重程度和治疗效果。

Abstract:

Objective To investigate the level of serum cytotoxic T lymphocyte antigen-4 (CTLA-4) in patients with idiopathic membranous nephropathy and its clinical significance. Methods Eighty patients with membranous nephropathy were selected as membranous nephropathy group, and 80 healthy subjects were selected as control group. The clinical information was collected, and the number of regulatory T cells in peripheral blood and the level of serum sCTLA-4 were determined. Results The serum albumin, regulatory cell count and sCTLA-4 level in the membranous nephropathy group were lower than those in the control group (P < 0.05), and levels of the serum creatinine and 24h urine protein were higher than those in the control group (P < 0.05). The serum albumin, regulatory cell count and sCTLA-4 level in the high-risk group of membranous nephropathy were lower than those in the low-risk group (P < 0.05), and serum creatinine and 24h urine protein were higher than those in the low-risk group (P < 0.05). The serum albumin, regulatory cell count and sCTLA-4 levels in patients with membranous nephropathy after treatment were higher than those before treatment (P < 0.05), and the serum creatinine and 24h urine protein levels were lower than those before treatment (P < 0.05). Compared with the ineffectiveness, the serum albumin, regulatory cell count and sCTLA-4 levels were elevated in patients with partial remission and complete remission (P < 0.05), and serum creatinine and 24h urine protein were decreased (P < 0.05). Compared with partial remission, the serum albumin, regulatory cell count and sCTLA-4 levels were elevated in patients with complete remission (P < 0.05), and the serum creatinine and 24h urinary protein were decreased (P < 0.05). The level of sCTLA-4 in membranous nephropathy was positively correlated with serum albumin and regulatory cells (P < 0.05), and negatively correlated with serum creatinine and 24h urine protein (P < 0.05). Conclusions The level of sCTLA-4 is decreased in patients with idiopathic membranous nephropathy, and can reflect the immune status, severity of disease and treatment effect in patients with idiopathic membranous nephropathy.