益肾降浊冲剂对慢性肾功能不全患者B淋巴细胞及调节性T细胞的影响

作者	单位
郑京	福建省人民医院肾病科
郑春盛	福建省人民医院肾病科
刘创	福建省人民医院肾病科
林上忠	福建省人民医院肾病科
高彦彦	福建省人民医院肾病科
陈雪兰	福建省人民医院肾病科
陈小丽	福建省人民医院肾病科

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中文摘要:

目的探讨益肾降浊冲剂对慢性肾功能不全(chronic renal insufficiency,CRI)患者B淋巴细胞、调节性T细胞(Treg)的影响。方法 53例CRI患者,根据治疗方案,采用随机数字表法分为治疗组(益肾降浊冲剂)和对照组,以流式细胞仪检测治疗前后慢性肾衰竭患者外周血Treg、B淋巴细胞百分率(CD19+)、活化率(CD19+CD69+)、凋亡率(AV)水平;用CBA流式蛋白分析系统检测外周血细胞因子IL-6、IL-10的水平;用散射速率比浊法测定血清高敏C反应蛋白(hs-CRP);用终点法测定同型半胱氨酸(Hcy);采用贝克曼库尔特血细胞分析仪查血红蛋白含量(HGB);由反相高效液相色谱测定方法测定尿肌酐(UCr);钙(Ca)、磷(P)、尿素氮(BUN)、血肌酐(SCr)、血浆白蛋白(Alb)由BECKMAN-C800全自动生化分析仪测定;根据血Ca、P浓度计算钙磷乘积(Ca×P);根据SCr、UCr和24h尿量计算内生肌酐清除率(CCr)。结果两组治疗后CD19+、CCr水平上升(P<0.01),AV、SCr水平下降(P<0.01),其中治疗组较对照组变化更明显(P<0.05);两组治疗后CD19+CD69+、Treg、IL-6、IL-10、CRP、BUN、P水平及Ca×P无明显变化(P>0.05)。两组治疗后Ca、HGB、Alb均上升(P<0.05),Hcy均下降(P<0.05),但两组比较差异无统计学意义(P>0.05)。相关性分析:CD19+与AV、Hcy呈负相关;AV与ALB呈负相关;SCr与CCr呈负相关,与CRP、BUN呈正相关;CCr与CRP、BUN呈负相关;Hcy与ALB呈负相关;CRP与BUN呈正相关。结论益肾降浊冲剂具有改善肾功能、延缓肾衰竭进展的作用。益肾降浊冲剂通过降低CD19+AV,提高其百分率而对CKD3、4期患者B淋巴细胞具有调节作用。

英文摘要:

Objective To explore the impacts of Yishen Jiangzhuo Granule (YJG) on peripheral blood B-cells and regulatory T-cells (Treg) in patients with chronic renal insufficiency (CRI). Methods Fifty-three CRI patients were randomly assigned to two groups,the control group and the YJG group. Before and after treatment,the following parameters in blood were detected:the peripheral Treg,percentage (CD19+),activation rate (CD19+CD69+) and apoptotic rate (AV) of B-lymphocyte by flow cytometry; cytokines (IL-6 and IL-10) by CBA stream protein analyzing system; high sensitivity C-reactive protein (hs-CRP) by scattering turbidimetric analysis; homocysteine(Hcy)by end-point method; hemoglobin (HGB) content by Beckman-Coulter hemo-analyser; blood contents of Ca,phosphate (P),blood urea nitrogen (BUN),creatinine (SCr) and plasma albumin (Alb) by automatic biochemical analyser; and urinary contents of creatinine (UCr) by inverse HPLC. Then the product of calcium-phosphate (Ca×P) was calculated based on blood contents of Ca2 and P and the clearance rate of endogenous creatinine (CCr) was calculated based on blood BUN and SCr. Results After treatment CD19+ and CCr significantly increased (P<0.01),but AV and SCr decreased in both groups(P<0.01),with the changes in the YJG group were more significant than those in the control group (P<0.05); levels of CD19+CD69+,Treg,IL-6,IL-10,CRP,BUN,P and Ca×P showed no significant change(P>0.05); levels of Ca2+,HGB and Alb increased as well as of Hcy in both groups (P<0.05). Correlation analysis:There were negative correlation in CD19+ with AV and Hcy; Alb with AV and Hcy; CCr with CRP,SCr and BUN,while positive correlation existed in SCr with CRP and BUN; and CRP with BUN. Conclusions YJG can improve renal function,and delay the progress of renal failure,and it also shows the regulatory effect on B lymphocytes by lowering the apoptosis rate and improving the percentage of CD19+ in patients.

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