慢性腎不全,血液透析患者における末梢血リンパ球サブセット・サイトカインの研究--同一患者における保存期・透析導入後の変化

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Uremic patients often present immune defects, which may have resulted from both uremia itself and dialysis. We analyzed the expressions of CD3, CD19, CD4, CD8, CD56, CD28, and CD80 on the surface of peripheral blood mononuclear cells (PBMCs) by flow cytometry, and interferon ( IFN ) -γ, interleukin (IL) -4, IL-10, and IL-12 mRNA levels on PBMCs using quantitative real-time RT-PCR in 14 chronic renal failure patients before the initiation of HD (nondialyzed: ND group) and after the patients were treated with hemodialysis (HD) for 1 year (HD group) . Sixteen healthy individuals were studied as normal controls (NC group) . The number of lymphocytes, both CD3+ T cells and CD19+B cells decreased in the ND and HD groups, with a decrease in the number of CD4+T cells. The numbers of CD3-CD56+ natural killer (NK) cells were identical in all three groups. HD normalized the CD28 expression level on T cells, which was low in ND patients, while HD diminished the CD80 expression level on B cells. The mRNA levels of the four cytokines were comparable between the ND and NC groups ; however, the HD group showed a decreased expression level of IL-4 mRNA and increased expression levels of IL-12 and IL-10 mRNAs although the expression level of IFN-γ mRNA did not change. Moreover, an increase in the IL-10 mRNA expression level was notable. Conclusions. In ND patients, helper T and B lymphopenia and a deficiency in the CD28 costimulatory molecule may play critical roles in the development of immune defects. HD normalized the expression level of CD28 but altered the expression levels of cytokines, particularly that of IL-10 mRNA.

慢性腎不全,血液透析患者における末梢血リンパ球サブセット・サイトカインの研究--同一患者における保存期・透析導入後の変化

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