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目的 :通过测定血浆中sFasL水平和外周血T淋巴细胞亚群状态的分析 ,探讨黄芪对改善尿毒症患者肾功能可能的机制。方法 :采用流式细胞仪和ELISA方法测定 2 5例尿毒症患者黄芪治疗前后及 2 0例正常人血浆中sFasL水平和外周血淋巴细胞亚群状态 ,以及患者治疗前后的肾功能变化。结果 :与正常人比较 ,尿毒症患者血浆中可溶性Fas配体 (sFasL)水平明显升高 ;CD3 + CD4 + 细胞的百分率明显下降 ,CD8+ 细胞的百分率明显升高 ,CD4 + /CD8+的比例小于 1(P <0 .0 1)。 2 5例患者黄芪治疗后血浆中sFasL水平降低 (P <0 .0 5 )。CD4 + /CD8+ 的比例升高 (P <0 .0 1) ;肌酐 (Scr)和尿素氮 (BUN)水平亦有不同程度降低 (P <0 .0 5 )。且动态观察 12例尿毒症患者血肌酐和尿素氮的下降与血浆中sFasL水平的下调呈正相关 (r =0 .5 6 ,P <0 .0 1)。结论 :黄芪能改善尿毒症患者的肾功能 ,提高患者的细胞免疫功能及减慢患者的细胞凋亡是其可能的机制之一。
OBJECTIVE: To investigate the possible mechanism of Astragalus membranaceus on improving renal function in patients with uremia by measuring the level of sFasL in plasma and the status of T lymphocyte subsets in peripheral blood. Methods: The levels of sFasL and peripheral blood lymphocyte subsets in 25 patients with uremia before and after treatment with Astragalus membranaceus and 20 normal subjects were determined by flow cytometry and ELISA, and the changes of renal function in patients before and after treatment. Results: The levels of soluble Fas ligand (sFasL) in plasma increased significantly in patients with uremia, the percentage of CD3 + CD4 + cells was significantly decreased, the percentage of CD8 + cells was significantly increased, and the ratio of CD4 + / CD8 + was less than 1 (P <0. 01). Serum levels of sFasL in 25 patients treated with astragalus decreased (P <0.05). The ratio of CD4 + / CD8 + increased (P <0.01), and the levels of creatinine (Scr) and blood urea nitrogen (BUN) decreased to some extent (P <0.05). Dynamic observation of serum creatinine and urea nitrogen in 12 patients with uremia was positively correlated with the decrease of plasma sFasL level (r = 0.56, P <0.01). Conclusion: Astragalus can improve renal function in patients with uremia, improve cellular immune function and slow down the apoptosis of patients is one of the possible mechanisms.