The Immunodys Regulation Of Th9,Th2,Treg In Peripheral Blood Of Patients With Idiopathic Membranous Nephropathy And The Correlation With Disease Activity

Objective To explore the correlation between the parameters and the degree of disease activity by observing the changes of Th9,Th2,Th1 and Treg cells in peripheral blood of patients with Idiopathic menbranous nephropathy(IMN),which might indicate that the possible immunological mechanism involved in IMN.Methods We collected the peripheral blood of 50 cases initial diagnosed as IMN by our department and 33 cases healthy controls(H controls)from February 2016 to December 2016,to detected T and Th cells subsets by flow cytometry.Dividing IMN patients into low risk group(LR group,24 h proteinuria < 4 g/24 h and albumin > 20 g/l)in 11 cases,and medium-high risk group(M-HR,24 h proteinuria ? 4 g/24 h,or albumin ? 20 g/l)in 39 cases.To compare the clinipathological features between the M-HR group and LR group,and the ratios of CD3+CD4~+,CD3+CD8~+,CD4~+/CD8~+,Th9,Th2,Th1,Treg,Th2/Th9,Th1/Th2 in the three groups.We evaluated the efficacy of therapy in the sixth month and the twelfth month,to analyze the immunoregulation changes of Th cell subsets in IMN patients with partial remission and completeremission before and after therapy.Results(1)The clinicopathological data analysis of IMN patients:(1)IMN patients were more common in the middle-aged and elderly men.The performance of Nephrotic syndrome and 24 h urinary protein was higher in the M-HR group than that in the LR group(P < 0.05);(2)The pathological stage of IMN patients was mainly in stage?(70%),and the immunofluorescence of Ig G4 was the strongest in Ig G subclasses.87.2% of M-HR group were mainly deposited with Ig G4,and 63.6% of Ig G1 were mainly in LR group.(2)The immunodysregulation of T and Th cells subsets in peripheral blood:(1)In M-HR group the ratios of CD3+CD4~+ and CD4~+/CD8~+ in peripheral blood of IMN patients were higher than that in the H group(P < 0.05);(2)The percentages of Th9,Th2 and Th1 cells in the M-HR group were significantly higher than that in the H group(P < 0.05),further the percentage of Th9 and Th2 in the M-HR group were significantly higher than that in the LR group(P <0.05),while the percentages of Treg cells,Th2/Th9 in M-HR group and LR group were significantly lower than that in H group(P < 0.05);(3)With the following up,there were 20 cases of partial remission and complete remission in5 cases,whose Th9,Th2 and Th1 cells were significantly lower and the ratios of Th2/Th9 higher than those pretherapy(P < 0.05);(4)There were significantly positive correlations among Th9,Th2 and 24 h urinary protein,Ig G4(P < 0.05).Conclusion(1)IMN patients were more common in the middle-aged and elderly men,with the mainly pathology in stage? and the immunofluorescence of Ig G4 was the strongest in Ig G subclasses.M-HR group were mainly deposited with Ig G4,however LR group were primarily in Ig G1.(2)The peripheral blood T cells subsets of IMN patients were primarily in CD4~+ T cells,accompanied with Th9,Th2 and Th1 cells increasing,Treg cells and the ratio of Th2/Th9 decreasing.With the alleviation of IMN,Th9,Th2 and Th1 cells decreased,Th2/Th9 increased.The Th9 and Th2 cells both positive correlations with the 24 h urine protein and Ig G4.(3)Suggesting that Th9 may involve in the immunoregulatory mechanisms of IMN,and its overexpression was associated with the disease activity.