Based On CD4+ T Lymphocytes, The Mechanism Of Action Of Jianpi Qushiheluo Formula In The Treatment Of Idiopathic Membranous Nephropathy Was Explored

Objective?To observe whether Jianpi Qushi Heluo decoction has influence on the level of peripheral blood CD4+T lymphocyte subsets and IgG4,IL-4 and IL-17 in patients with idiopathic membranous nephropathy(IMN)of spleen kidney qi deficiency and damp heat syndrome,so as to explore the mechanism of Jianpi Qushi Heluo decoction in the treatment of IMN.Methods:Case-control study and before-after study in the same patient were used in this study.To include IMN patients with spleen kidney qi deficiency and damp heat syndrome and comparable healthy people who meet the inclusion and exclusion criteria in the outpatient and inpatient departments of Nephrology Department of Xiyuan Hospital,Chinese Academy of traditional Chinese medicine.Patients with IMN were treated with Jianpi Qushi Heluo decoction for 24 weeks on the basis of routine basic treatment.The curative effect was observed before treatment and after 8,16 and 24 weeks of treatment.The peripheral blood samples of healthy people and IMN patients were collected before treatment and after 24 weeks of treatment,and peripheral blood mononuclear cells were extracted.The proportion of Th1/Th2/Th17/Treg cells was characterized by immunophenotype method,and detected by flow cytometry.The levels of IgG4,IL-4 and IL-17 were detected by enzyme-linked immuno sorbent assay.Results:(1)a total of 26 patients with IMN and 10 healthy people were included.The 24-hour urinary protein of IMN patients was 2.50±1.18 g before treatment,and 2.06±1.43 g and 1.46±1.32 g after 16 and 24 weeks of treatment respectively,which was significantly lower than that before treatment(P<0.05).With the prolongation of treatment,the total remission rate continued to increase.After 24 weeks of treatment,9 patients with IMN had partial remission,6 patients with IMN had complete remission,and the total remission rate was 57.7%.During the follow-up period,the liver function and blood routine of patients with IMN were in the normal range,and the renal function had no significant change(P>0.05).(2)Compared with the healthy group,the levels of Th1,Th17,Th1/Th2 and Th1/Treg in the high-risk IMN group were significantly increased,the levels of Th1,Th1/Th2,Th1/Treg and Th17/Treg in the low-risk IMN group were significantly increased,the levels of Th2,Treg,IgG4,IL-4 and IL-17 in this two groups were significantly decreased(P<0.05).There was no significant difference in peripheral blood CD4+T lymphocyte subsets,IgG4,IL-4 and IL-17 between IMN patients with and without immunosuppression(P>0.05).(3)After 24 weeks of treatment,Th1,Th1/Th2 and Th1/Treg were significantly decreased,Th2 was significantly increased,IgG4 and IL-17 were also significantly decreased(P<0.05).(4)The patients with IMN were divided into two groups:the effective group and the ineffective group.The levels of Th1,Th1/Th2,Th1/Treg and Th17/Treg in the effective group after 24 weeks of treatment were significantly lower than those in the effective group before treatment,the levels of Treg were significantly higher,and the levels of IgG4 and IL-17 were also significantly lower(P<0.05).There was no significant difference in peripheral blood CD4+T lymphocyte subsets and IgG4,IL-4 and IL-17 before and after treatment in ineffective group(P>0.05).There was no significant difference in peripheral blood CD4+T lymphocyte subsets and IgG4,IL-4 and IL-17 between effective group and ineffective group before treatment(P>0.05).After treatment,the levels of Th17,Thl/Treg and Th17/Treg in the effective group were significantly lower than those in the ineffective group,and the level of Treg in the effective group was significantly higher than that in the ineffective group(P<0.05).Conclusion:(1)patients with IMN have disorder of CD4+T lymphocyte subsets in peripheral blood,and the level of inflammation is increased.The main manifestations are that Th1,Th1/Th2 and Th1/Treg are significantly increased,Th2 and Treg are significantly decreased,and IgG4,IL-4 and IL-17 are also significantly increased.However,there is no correlation between the severity of IMN and the levels of CD4+T lymphocyte subsets,IgG4,IL-4 and IL-17.(2)Jianpi Qushi Heluo decoction can effectively reduce proteinuria and improve the clinical remission rate of IMN patients.The mechanism may be related to the decrease of Thl and Th17 cell ratio,the ratio of Th1/Th2,Thl/Treg and Th17/Treg,the increase of Treg cell ratio and the decrease of IL-17 level in patients with IMN,so as to exert immunosuppression,reduce the level of peripheral blood inflammation,reduce the infiltration of renal inflammatory cells and alleviate renal injury.In addition,Jianpi Qushi Heluo decoction can reduce the level of IgG4 in peripheral blood,but whether it can reduce the formation and deposition of immune complex needs further study.