目的 通过观察激素治疗前、后原发性肾病综合征(PNS)患儿外周血淋巴细胞亚群的变化,探讨儿童PNS的发病机制.方法 选择PNS患儿47例,其中单纯型肾病(SNS)31例,肾炎型肾病(NNS) 16例,同时选择20例健康体检儿童作为正常对照组；激素治疗前、后分别采用流式细胞术检测外周血CD3+、CD3+ CD4+、CD3+ CD8+、CD4+ CD25+、B细胞和NK细胞比例.结果 与正常对照组比较,治疗前SNS组和NNS组患儿外周血CD3+ CD4+、CD4+ CD25+和NK细胞比例明显降低(P＜0.05或P＜0.01),CD3+ CD8+和B细胞比例显著升高(P＜0.01).激素治疗后,SNS组28例(占90.32％)患儿得到缓解,NNS组11例(占68.75％)患儿得到缓解；与治疗前比较,治疗后SNS组和NNS组缓解患儿外周血CD3+ CD8+和B细胞比例均明显下降(P＜0.05),CD3+ CD4+、CD4+ CD25+和NK细胞比例显著升高(P＜0.05或P＜0.01).结论 儿童PNS的发病机制可能与CD3+CD4+、CD4+ CD25+和NK细胞的下降以及CD3+ CD8+和B细胞升高有关,激素可通过调节淋巴细胞各亚群比例发挥治疗作用.%Objective To explore the pathogenesis of primary nephrotic syndrome(PNS) in children by observing the changes of lymphocyte subsets in peripheral blood before and after hormone treatment.Methods 47 cases of children with PNS were selected including 31 cases of simple nephrotic syndrome(SNS) and 16 cases of nephritis nephropathy syndrome(NNS),while 20 cases of healthy children were selected as normal control group;Flow cytometry was used to detected the proportion of CD3+,CD3+ CD4+,CD3+ CD8+,CD4+ CD25+,B cells and NK cells in peripheral blood before and after hormone therapy.Results Compared with the normal control group,the proportion of CD3+ CD4+,CD4+ CD25+ and NK cells in peripheral blood of children in SNS group and NNS group significantly reduced before treatment(P＜0.05 or P＜0.01),while the CD3+ CD8+ and B cells proportion significantly increased(P＜0.01).28 patients(90.32％) had been alleviated in SNS group,and 11 patients(68.75％) had been alleviated in NNS group after hormone therapy; compared with pre-hormone therapy,the proportion of CD3+ CD8+ and B cells of children with remission in SNS and NNS group were significantly decreased after treatment(P＜0.05),CD3+ CD4+,CD4+ CD25+ and NK cells proportion was significantly higher(P＜0.05 or P＜0.01).Conclusion The pathogenesis of PNS in children may be relate to the decline of CD3+ CD4+,CD4+ CD25+ and NK cells,and CD3+ CD8+ and B cells' increation,hormones plays a therapeutic effect by adjusting lymphocyte subsets proportion.
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