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目的观察甲状旁腺激素(PTH)对维持性血液透析患者外周血调节性T细胞(Treg)和微炎症的影响。方法选取27例合并甲状腺旁腺功能亢进的血液透析患者(高PTH组)、18例无甲状腺旁腺功能亢进的血液透析患者(低PTH组)和20名健康人,采用流式细胞术检测各组外周血中CD4+、CD25+、CD127-来定义其外周血中Treg细胞表达的百分比,同时通过免疫比浊法和酶联免疫吸附法(ELISA)检测各组血清C-反应蛋白(CRP)、血清白细胞介素-6(IL-6)、肿瘤坏死因子-a(TNF-a)。结果两组血液透析患者的Treg细胞较健康对照组明显减少(P<0.05),而两组的CRP,IL-6,TNF-a均显著增高(P<0.05);血液透析伴高PTH组的Treg细胞显著低于低PTH组(P<0.05),而其CRP,IL-6,TNF-a水平显著高于低PTH组(P<0.05)。结论高PTH可抑制T细胞分化,减少Treg产生,促使炎症因子增高。积极清除PTH,可能对改善血液透析患者免疫功能有益。
Objective To investigate the effect of parathyroid hormone (PTH) on peripheral blood Tregs and microinflammation in maintenance hemodialysis patients. Methods Twenty-seven hemodialysis patients (high PTH group) with hyperparathyroidism, 18 hemodialysis patients without hypothyroidism (low PTH group) and 20 healthy volunteers were enrolled in this study. Flow cytometry The percentage of Treg cells in peripheral blood was defined by CD4 +, CD25 + and CD127- in peripheral blood and the levels of C-reactive protein (CRP) and serum in each group were detected by immunoturbidimetric assay and enzyme-linked immunosorbent assay (ELISA) Interleukin-6 (IL-6), Tumor Necrosis Factor-a (TNF-a). Results The Treg cells in hemodialysis patients were significantly lower than those in healthy controls (P <0.05), while the levels of CRP, IL-6 and TNF-α were significantly increased in both groups (P <0.05) Treg cells were significantly lower than those in the low PTH group (P <0.05), while the levels of CRP, IL-6 and TNF-a were significantly higher than those in the low PTH group (P <0.05). Conclusion High PTH can inhibit T cell differentiation, reduce Treg production, and promote inflammatory cytokines. Active removal of PTH may be beneficial to improving immune function in hemodialysis patients.