儿童论文：儿童原发性肾病综合征的免疫功能与中医证型及病理类型的相关性研究.doc

儿童论文：儿童原发性肾病综合征的免疫功能与中医证型及病理类型的相关性研究【中文摘要】1.研究儿童原发性肾病综合征的T细胞亚群和体液免疫与中医证型之肝肾阴虚证和脾肾阳虚证之间的相关性。2.研究儿童原发性肾病综合征的T细胞亚群和体液免疫与病理类型之微小病变和系膜增生性病变之间的相关性。3.研究儿童原发性肾病综合征的T细胞亚群与体液免疫之间的相关性。方法：1.对满足年龄为18岁的原发性肾病综合征住院患者均检查24h尿蛋白定量、血浆胆固醇、血浆白蛋白、CD3+%、CD4+CD3+%、CD8+CD3+%、CD4+/CD8+、IgG、IgA、IgM、IgE、C3、C4等指标,并选择中医辨证分型为肝肾阴虚证和脾肾阳虚的病例,通过肾活检确定患者的病理类型。2.将满足条件的40例患者分为肝肾阴虚证组(n=19)和脾肾阳虚证组(n=21)。在两组均服从正态分布和满足方差齐性的条件下,用成组t检验；不服从正态分布或方差不齐时,用Wilcoxon秩和检验,分别比较两组CD3+%、CD4+CD3+%、CD8+CD3+%、CD4+/CD8+、IgG、IgA、IgM、IgE、C3、C4的差异。3.将满足条件的35例患者分为微小病变组(n=18)和系膜增生性病变组(n=17)。在两组均服从正态分布和满足方差齐性的条件下,用成组t检验；不服从正态分布或方差不齐时,用Wilcoxon秩和检验,分别比较两组CD3+%、CD4+CD3+%、CD8+CD3+%、CD4+/CD8+、IgG、IgA、IgM、IgE、C3、C4的差异。4.将满足条件的40例儿童PNS患者的CD3+%、CD4+CD3+%、CD8+CD3+%、CD4+/CD8+使用多元线性逐步回归方法逐个分析与IgG、IgA、IgM、IgE、C3、C4的相关性。结果：1.大部分儿童原发性肾病综合征患者的尿蛋白、血浆白蛋白、胆固醇符合原发性肾病综合征的诊断标准。2.40例儿童PNS患者,肝肾阴虚证19例(占47.5%),脾肾阳虚证21例(占52.5%),MCD 18例(占45.0%),MsPGN 17例(占42.5%),MPGN2例(占5.0%),MN 2例(占5.0%), FSGS1例(占2.5%)。3.儿童PNS脾肾阳虚证患者CD3+%较肝肾阴虚证患者高(P0.05)；儿童PNS脾肾阳虚证患者CD8+%CD3+%与肝肾阴虚证患者CD8+CD3+%分布不同(P0.05)；尚不能认为儿童PNS脾肾阳虚证患者与肝肾阴虚证患者的CD4+CD3+%、CD4+/CD8+有差异。4.尚不能认为儿童PNS脾肾阳虚证患者与肝肾阴虚证患者的IgG、IgA、IgM、IgE、C3、C4水平分布有差异。5.尚不能认为儿童PNS微小病变患者与系膜增生性病变患者的CD3+%、CD4+CD3+%、CD8+CD3+%、CD4+/CD8+有差异。6.尚不能认为儿童PNS微小病变患者与系膜增生性病变患者的IgG、IgA、IgM、IgE、C3、C4水平有差异。7.儿童PNS患者CD3+%与IgE呈证相关(r=0.330)；CD4+CD3+%与IgE呈正相关(r=0.371)；CD4+CD3+%与IgM呈正相关(r=0.482),且较CD4+CD3+%与IgE的正相关程度强；CD8+CD3+%与IgM呈正相关(r=0.443)；CD4+/CD8+与IgM呈正相关(r=0.557)。结论：1.儿童PNS脾肾阳虚证患者CD3+%较肝肾阴虚证患者高,脾肾阳虚证患者与肝肾阴虚证患者的CD8+CD3+%分布不同,而CD4+CD3+%、CD4+/CD8+、IgG、IgA、IgM、IgE、C3、C4无差异。2.儿童PNS微小病变患者与系膜增生性病变患者的CD3+%、CD4+CD3+%、CD8+CD3+%、CD4+/CD8+、IgG、IgA、IgM、IgE、C3、C4均无差异。3.儿童PNS患者CD3+%与IgE呈正相关；CD4+CD3+%与IgE、IgM呈正相关；CD8+CD3+%、CD4+/CD8+均与IgM呈正相关。【英文摘要】s:1.To study the correlation relationship between T lymphocyte subsets, humoral immune and Chinese Medicine Syndrome Types in children with primary nephrotic syndrome.2.To study the correlation relationship between T lymphocyte subsets, humoral immune and pathologic types in children with primary nephrotic syndrome.3.To study the correlation relationship between T lymphocyte subsets and humoral immune in children with primary nephrotic syndrome.Methods:1.24h proteinuria excretion, plasma cholesterol, plasma albumin, CD3+%, CD4+CD3+%, CD8+CD3+%, CD4+/CD8+, IgG, IgA, IgM, IgE, C3 and C4 are performed in children with primary nephrotic syndrome, whose age are 1 and 18.liver-kidney Yin deficiency syndrome and spleen-kidney Yang deficiency syndrome are selected as the studied subjects, and obtained pathological types by means of kidney biopsy.2.40 patients with primary nephrotic syndrome are divided into liver-kidney Yin deficiency syndrome group (n=19) and spleen-kidney Yang deficiency syndrome group (n=21). The two groups are performed with independent samples group t test based on normal distribution and homogeneity of variance,or performed with two independent samples nonparametric test based on non-normal Distributions or heterogeneity of variance. CD3+%, CD4+CD3+%, CD8+CD3+%, CD4+/CD8+, IgG, IgA, IgM, IgE, C3 and C4 are separately compared.3.35 patients with primary nephrotic syndrome were divided into minimal change disease group (n=18) and mesangial proliferative glomerulonephritis group (n=17), the two goups are performed with independent samples group t test based on normal distribution and homogeneity of variance,or performed with two independent samples nonparametric test based on non-normal Distributions or heterogeneity of variance. CD3+%, CD4+CD3+%, CD8+CD3+%, CD4+/CD8+, IgG, IgA, IgM, IgE, C3 and C4 are separately compared.4.The correlation relationship between CD3+%, CD4+CD3+%, CD8+CD3+%, CD4+/CD8+, IgG，IgA, IgM, IgE, C3 and C4 is evaluated by multiple linear stepwise regressions analysis in children with primary nephrotic syndrome.Results:1.Most of urine protein, plasma albumin and plasma cholesterol in children with primary nephrotic syndrome accord with primary nephrotic syndrome diagnosis criteria.2.Of all the 40 patients in children with primary nephrotic syndrome, liver-kidney Yin deficiency syndrome 19 cases, accounts for 45.0%, spleen-kidney Yang deficiency syndrome 21 cases,accounts for 52.5%. minimal change disease 18 cases, accounts for 45.0%,mesangial proliferative glomerulonephritis 17 cases, accounts for 42.5%, membrane proliferative glomerulonephritis 2 cases, accounts for 5.0%, membranous nephropathy 2 cases,accounts for 5.0%, focal segmental glomerulosclerosis 1 cases, accounts for 2.5%.3.The CD3+% of spleen-kidney Yang deficiency syndrome in children with primary nephrotic syndrome is higher than liver-kidney Yin deficiency syndrome (P0.05). The CD8+CD3+% of spleen-kidney Yang deficiency syndrome in children with primary nephrotic syndrome is different from liver-kidney Yin deficiency syndrome (P0.05). Still cant think that CD4+CD3+% and CD4+/CD8+ of liver-kidney Yin deficiency syndrome and spleen-kidney Yang deficiency syndrome in children with primary nephrotic syndrome have the difference.4.Still cant think that IgG, IgA, IgM, IgE, C3 and C4 of liver-kidney Yin deficiency syndrome and spleen-kidney Yang deficiency syndrome in children with primary nephrotic syndrome have the difference.5.Still cant think that CD3+%, CD4+CD3+%, CD8+CD3+% and CD4+/CD8+ of minimal change disease and mesangial proliferative glomerulonephritis in children with primary nephrotic syndrome have the difference.6.Still cant think that IgG, IgA, IgM, IgE, C3 and C4 of minimal change disease and mesangial proliferative glomerulonephritis in children with primary nephrotic syndrome have the difference.7.CD3+% is correlated positively with IgE (r= 0.330).CD4+CD3+% is correlated positively with IgE (r=0.371) and IgM (r=0.482). The correlation relationship between CD4+CD3+% and IgM are stronger than IgE. CD8+CD3+% is correlated positively with IgM (r=0.443). CD4+/CD8+ is correlated positively with IgM (r=0.557)Conclusions:1.The CD3+% of spleen-kidney Yang deficiency syndrome in children with primary nephrotic syndrome is higher than liver-kidney Yin deficiency syndrome. The CD8+CD3+% of spleen-kidney Yang deficiency syndrome in children with primary nephrotic syndrome is different from liver-kidney Yin deficiency syndrome. Still cant think that CD4+CD3+% and CD4+/CD8+ of liver-kidney Yin deficiency syndrome and spleen-kidney Yang deficiency syndrome in children with primary nephrotic syndrome have the difference. 2.Still cant think that CD3+%,CD4+CD3+%,CD8+CD3+%,CD4+/CD8+,IgG, IgA,IgM,IgE,C3 and C4 of minimal change disease and mesangial prolif.erative glomerulonephritis in children with primary nephrotic syndrome have the difference.3.CD3+% is correlated positively with IgE.CD4+CD3+%is correlated positively with IgE and IgM.The orrelation relations