ESRD患者细胞免疫功能与氧化应激关联的研究

目的观察终末期肾脏病（ESRD）患者T淋巴细胞亚群的变化及与氧化应激的关联。方法选择住院和门诊ESRD患者40例，其中20例接受血液透析治疗，为I组；另20例未接受血液透析治疗，为Ⅱ组；选择同期健康体检者20例为Ⅲ组。检测3组血清超氧化物歧化酶（SOD）、丙二醛（MDA）和T淋巴细胞亚群、凋亡。结果①与Ⅲ组比较，ESRD患者CD3＋、CD4＋T细胞数及CD4＋／CD8＋比值均显著下降（P〈0．05）；而CD3＋、CD4＋T细胞凋亡率显著升高（P〈0．01）；两者呈负相关（r=-0．79，P〈0．01；r=-0．87，P〈0．01）。②与Ⅲ组比较，ESRD患者血清MDA明显升高（P〈0．05），SOD明显下降（P〈0．05）；并且CD3＋、CD4＋T细胞凋亡率与MDA呈正相关（r=0．41，P〈0．05；r=0．58，P〈0．01）。结论ESRD患者T淋巴细胞亚群数量减少与其凋亡率相关，后者又与氧化应激状态关联。因此推测氧化应激可能诱导淋巴细胞过度凋亡，促使细胞数减少。加重ESRD患者免疫功能紊乱。

Correlation between Cellular Immune Function and Oxidative Stress in Patients with End-stage Renal Disease

Objective To investigate the change of T lymphocyte subsets and oxidative stress of end-stage renal disease （ESRD） , and analyze their correlation. Methods Forty ESRD patients in our hospital were enrolled. Twenty cases received he- modialysis as group Ⅰ , and the rest 20 patients were not subjected to hemodialysis as group Ⅱ. Twenty healthy persons over the same period served as group Ⅲ. Superoxide dismutase （SOD） , malonaldehyde（MDA） ,T lymphocyte subsets and apoptosis were detected. Results （1）As compared with group Ⅲ, ESRD patients had the decreased percentage of CD3 ＋ , CD4＋T cell and CD4 ＋/CD8 ＋ ratio （ P 〈 0. 05 ）, while the apoptosis rate of CD3＋ cell, CD4 ＋ T lymphocyte cell was increased （ P 〈 0. 01 ）, which was negatively correlated with corresponding cell number（ r = - 0. 79, P 〈 0. 01 ; r = - 0.87, P 〈 0. 01 ）. （2）As compared with group Ⅲ, ESRD patients had the higher lever of MDA and the lower lever of SOD（ P 〈 0. 05 ） ; and the apoptosis rate of CD3 ＋ , CD4 ＋ T lymphocyte cell were obvious positively correlated with MDA（ r = 0.41 , P 〈 0.05 ; r = 0.58 , P 〈 0.01 ）. Conclusion The percentage of T-lymphocyte subsets were decreased in ESRD patients, and were negatively related with the apoptosis of corre- sponding cell, which in turn correlated with oxidative stress, thus, we could speculate that oxidative stress induced lymphocyte excessive apoptosis and promoted cell number were decreased, which eventually aggravated immune dysfunction in ESRD patients.