维持性血液透析患者与AIDS患者的免疫功能比较
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摘要
目的对比分析维持性血液透析(血透)患者和获得性免疫缺陷综合征(AIDS)患者的免疫功能状态。方法选取2017年5月—8月在会理县人民医院进行长期维持性血透的60例尿毒症患者(维持性血透组)和60例在本院抗病毒中心接受治疗已确诊为AIDS的患者(AIDS组),另选60例常规体检人群作为健康对照组。采用SYSMEX XT-2000 I血球分析仪检测白细胞计数(WBC)和淋巴细胞计数(Lym),采用BDFACSCOUNT流式细胞仪检测CD3~+CD4~+、CD3~+CD8~+和CD3~+T细胞计数和CD4/CD8比值,统计数据并进行分析。结果与健康对照组比较,维持性血透组患者的Lym和CD3~+CD4~+、CD3~+CD8~+、CD3~+T细胞计数均明显降低[Lym(×109/L):1.12(0.85,1.44)比1.91(1.52,2.30),CD3~+CD4~+T细胞(×106/L):414.00(303.00,559.25)比627.00(517.50,823.75),CD3~+CD8~+T细胞(×106/L):271.00(167.50,398.50)比453.00(384.80,620.50),CD3~+T细胞(×106/L):783.00(466.00,999.75)比1 207.00(1 011.50,1 518.00)];AIDS组患者的CD3~+CD4~+T细胞计数和CD4/CD8比值均明显降低[CD3~+CD4~+T细胞(×106/L):433.00(290.25,547.25)比627.00(517.50,823.75),CD4/CD8比值:0.53(0.31,0.78)比1.36(0.95,1.76)],CD3~+CD8~+T细胞计数明显升高[×106/L:819.00(594.50,1 015.80)比453.00(384.80,620.50)],差异均有统计学意义(均P<0.05)。与维持性血透组比较,AIDS组患者的Lym和CD3~+CD8~+、CD3~+T细胞计数均明显升高[Lym(×109/L):1.84(1.62,2.40)比1.12(0.85,1.44),CD3~+CD8~+T细胞(×106/L):819.00(594.50,1 015.80)比271.00(167.50,398.50),CD3~+T细胞(×106/L):1 247.50(1 048.25,1 569.75)比783.00(466.00,999.75)],CD4/CD8比值明显降低[0.53(0.31,0.78)比1.62(1.20,2.10)],差异均有统计学意义(均P<0.05)。3组间WBC比较差异均无统计学意义(均P>0.05)。结论维持性血透患者不同亚群的T细胞均降低,AIDS患者仅CD3~+CD4~+T细胞降低,可认为维持性血透患者的免疫功能紊乱情况较AIDS患者更为严重。
Objective To compare the immune function status in maintenance hemodialysis patients and AIDS patients. Methods Sixty patients with uremia had undergone long-term maintenance hemodialysis and 60 cases had diagnosed as AIDS patients in HuiLi County People's Hospital from May to August 2017, and they were respectively assigned in a maintenance hemodialysis group and an AIDS group; in addition, another 60 persons having undergone routine physical examinations were included in a normal control group. The SYSMEX XT-2000 I blood cell analyzer was used to detect the white blood cell count(WBC) and lymphocyte(Lym) count, the BD FACSCOUNT flow cytometry was applied to measure CD3~+CD4~+ T cell, CD3~+CD8~+ T cell, CD3~+ T cell and CD4/CD8 ratio, and the data results were statistically analyzed. Results Compared with healthy control group, the numbers of Lym, CD3~+CD4~+ T cells, CD3~+CD8~+ T cells, CD3~+ T cells in the patients of maintenance hemodialysis group were significantly lower [Lym(×109/L): 1.12(0.85, 1.44) vs. 1.91(1.52, 2.30), CD3~+CD4~+ T cell(×106/L): 414.00(303.00, 559.25) vs. 627.00(517.50, 823.75), CD3~+CD8~+ T cell(×106/L): 271.00(167.50, 398.50) vs. 453.00(384.80, 620.50), CD3~+ T cell(×106/L): 783.00(466.00, 999.75) vs. 1 207.00(1 011.50, 1 518.00)]; the numbers of CD3~+CD4~+ T cells and the CD4/CD8 ratio in patients of AIDS group were lower than those in normal control group [CD3~+CD4~+ T cell(×106/L): 433.00(290.25, 547.25) vs. 627.00(517.50, 823.75), CD4/CD8 ratio: 0.53(0.31, 0.78) vs. 1.36(0.95, 1.76)], CD3~+CD8~+ T cells was obviously higher than that of the normal population [CD3~+CD8~+T cell(×106/L): 819.00(594.50, 1 015.80) vs. 453.00(384.80, 620.50)]; the differences in the above indexes were statistically significant(all P < 0.05). Compared with the maintenance hemodialysis group, the numbers of Lym, CD3~+CD8~+ T cells and CD3~+ T cells in patients of AIDS group were markedly higher [Lym(×109/L): 1.84(1.62, 2.40) vs. 1.12(0.85, 1.44), CD3~+CD8~+ T cell(×106/L): 819.00(594.50, 1 015.80) vs. 271.00(167.50, 398.50), CD3~+ T cell(×106/L): 1 247.50(1 048.25, 1 569.75) vs. 783.00(466.00, 999.75)], while CD4/CD8 ratio was significantly lower [0.53(0.31, 0.78) vs. 1.62(1.20, 2.10)], the differences in the above indexes were statistically significant(all P < 0.05). And there were no significant differences statistically in WBC number between any pair comparison in the 3 groups(all P > 0.05). Conclusions In patients of maintenance hemodialysis group, all the different T cell subsets are decreased, while in the patients in AIDS group, only are CD3~+CD4~+ T cells decreased. Therefore, it may be recognized that the immune dysfunction status in patients with maintenance hemodialysis is severer than that in patients with AIDS.
Objective To compare the immune function status in maintenance hemodialysis patients and AIDS patients. Methods Sixty patients with uremia had undergone long-term maintenance hemodialysis and 60 cases had diagnosed as AIDS patients in HuiLi County People's Hospital from May to August 2017, and they were respectively assigned in a maintenance hemodialysis group and an AIDS group; in addition, another 60 persons having undergone routine physical examinations were included in a normal control group. The SYSMEX XT-2000 I blood cell analyzer was used to detect the white blood cell count(WBC) and lymphocyte(Lym) count, the BD FACSCOUNT flow cytometry was applied to measure CD3~+CD4~+ T cell, CD3~+CD8~+ T cell, CD3~+ T cell and CD4/CD8 ratio, and the data results were statistically analyzed. Results Compared with healthy control group, the numbers of Lym, CD3~+CD4~+ T cells, CD3~+CD8~+ T cells, CD3~+ T cells in the patients of maintenance hemodialysis group were significantly lower [Lym(×109/L): 1.12(0.85, 1.44) vs. 1.91(1.52, 2.30), CD3~+CD4~+ T cell(×106/L): 414.00(303.00, 559.25) vs. 627.00(517.50, 823.75), CD3~+CD8~+ T cell(×106/L): 271.00(167.50, 398.50) vs. 453.00(384.80, 620.50), CD3~+ T cell(×106/L): 783.00(466.00, 999.75) vs. 1 207.00(1 011.50, 1 518.00)]; the numbers of CD3~+CD4~+ T cells and the CD4/CD8 ratio in patients of AIDS group were lower than those in normal control group [CD3~+CD4~+ T cell(×106/L): 433.00(290.25, 547.25) vs. 627.00(517.50, 823.75), CD4/CD8 ratio: 0.53(0.31, 0.78) vs. 1.36(0.95, 1.76)], CD3~+CD8~+ T cells was obviously higher than that of the normal population [CD3~+CD8~+T cell(×106/L): 819.00(594.50, 1 015.80) vs. 453.00(384.80, 620.50)]; the differences in the above indexes were statistically significant(all P < 0.05). Compared with the maintenance hemodialysis group, the numbers of Lym, CD3~+CD8~+ T cells and CD3~+ T cells in patients of AIDS group were markedly higher [Lym(×109/L): 1.84(1.62, 2.40) vs. 1.12(0.85, 1.44), CD3~+CD8~+ T cell(×106/L): 819.00(594.50, 1 015.80) vs. 271.00(167.50, 398.50), CD3~+ T cell(×106/L): 1 247.50(1 048.25, 1 569.75) vs. 783.00(466.00, 999.75)], while CD4/CD8 ratio was significantly lower [0.53(0.31, 0.78) vs. 1.62(1.20, 2.10)], the differences in the above indexes were statistically significant(all P < 0.05). And there were no significant differences statistically in WBC number between any pair comparison in the 3 groups(all P > 0.05). Conclusions In patients of maintenance hemodialysis group, all the different T cell subsets are decreased, while in the patients in AIDS group, only are CD3~+CD4~+ T cells decreased. Therefore, it may be recognized that the immune dysfunction status in patients with maintenance hemodialysis is severer than that in patients with AIDS.
引文
1Eleftheriadis T,Antoniadi G,Liakopoulos V,et al. Disturbances of acquired immunity in hemodialysis patients[J]. Semin Dial, 2007,20(5):440-451.
2 龚英峰,李顺利,杜勇,等.尿毒症患者免疫功能与营养状态的相关性分析[J].检验医学与临床,2015,12(8):1042-1044.
3 郑晓勇,严海东,李曼,等.血液透析对尿毒症患者外周血T细胞亚群的影响[J].中国实用内科杂志,2002,22(5):275-276.
4 Lisowska KA,D?bska-?lizieńA,Jasiulewicz A,et al. Hemodialysis affects phenotype and proliferation of CD4-positive T lymphocyte[J].J Clin Immunol, 2012,32(1):189-200.
5 解德琼,甘华,杜晓刚,等.不同透析膜对维持性血液透析患者外周血T细胞凋亡的影响[J].中华肾脏病杂志,2006,22(12):738-742.
6 周文华,王关乔,杨爱华.维持性血液透析患者恶性肿瘤的发生情况[J].现代实用医学,2010,22(12):1340-1341.
7 涂晓文,刘晓莉,许倬,等.高通量血液透析对尿毒症患者甲状旁腺激素和微炎症状态的影响[J].中华危重病急救医学,2014,26(4):275-276.
8 黄飞,林鹏,李艳.艾滋病预防控制工作指南[M].广州:中山大学出版社,2009.
9 黄丽芬,唐小平,蔡卫平,等.广东地区HIV/AIDS患者机会性感染特点与CD4+之间的关系[J].热带医学杂志,2007,7(6):582-584.
10 张应宣,沈刚,赵磊.HIV感染/患者CD4+T淋巴细胞变化与死亡情况分析[J].中外医学研究,2015,13(3):74-76.
11 沙丽娜,刘磊,尹松鹤,等.牡丹江市HIV感染者/病人首次CD4+T淋巴细胞检测结果分析[J].医学动物防制,2015,31(10):1177-1179.
12 刘楚钿,曾常红,何由成,等.广东省169例HIV感染者CD4+/CD8+水平及相关情况分析[J].华南预防医学,2008,34(3):40-42.
13 张清仲,符林春,岑玉文,等.广东HIV/AIDS患者舌象分析及其与CD4、CD8、CD4/CD8计数的相关性研究[J].免疫学杂志,2010,26(4):325-328.
2 龚英峰,李顺利,杜勇,等.尿毒症患者免疫功能与营养状态的相关性分析[J].检验医学与临床,2015,12(8):1042-1044.
3 郑晓勇,严海东,李曼,等.血液透析对尿毒症患者外周血T细胞亚群的影响[J].中国实用内科杂志,2002,22(5):275-276.
4 Lisowska KA,D?bska-?lizieńA,Jasiulewicz A,et al. Hemodialysis affects phenotype and proliferation of CD4-positive T lymphocyte[J].J Clin Immunol, 2012,32(1):189-200.
5 解德琼,甘华,杜晓刚,等.不同透析膜对维持性血液透析患者外周血T细胞凋亡的影响[J].中华肾脏病杂志,2006,22(12):738-742.
6 周文华,王关乔,杨爱华.维持性血液透析患者恶性肿瘤的发生情况[J].现代实用医学,2010,22(12):1340-1341.
7 涂晓文,刘晓莉,许倬,等.高通量血液透析对尿毒症患者甲状旁腺激素和微炎症状态的影响[J].中华危重病急救医学,2014,26(4):275-276.
8 黄飞,林鹏,李艳.艾滋病预防控制工作指南[M].广州:中山大学出版社,2009.
9 黄丽芬,唐小平,蔡卫平,等.广东地区HIV/AIDS患者机会性感染特点与CD4+之间的关系[J].热带医学杂志,2007,7(6):582-584.
10 张应宣,沈刚,赵磊.HIV感染/患者CD4+T淋巴细胞变化与死亡情况分析[J].中外医学研究,2015,13(3):74-76.
11 沙丽娜,刘磊,尹松鹤,等.牡丹江市HIV感染者/病人首次CD4+T淋巴细胞检测结果分析[J].医学动物防制,2015,31(10):1177-1179.
12 刘楚钿,曾常红,何由成,等.广东省169例HIV感染者CD4+/CD8+水平及相关情况分析[J].华南预防医学,2008,34(3):40-42.
13 张清仲,符林春,岑玉文,等.广东HIV/AIDS患者舌象分析及其与CD4、CD8、CD4/CD8计数的相关性研究[J].免疫学杂志,2010,26(4):325-328.