中文摘要：

目的： 通过研究尿毒症患者外周血维甲酸相关孤儿受体γt （RORγt）和叉头框P3蛋白（Foxp3）mRNA的表达,明确调节性T细胞（Treg细胞）和辅助性T细胞17（Th17细胞）在尿毒症患者中的变化情况,探讨这种变化与尿毒症患者微炎症状态的关系。方法： 选取尿毒症患者30例,其中未接受透析治疗的10例,维持性血液透析患者20例,年龄及性别相匹配的健康志愿者20例。采用实时荧光定量聚合酶链反应（RT-PCR）、酶联免疫吸附测定（ELISA）和免疫透射比浊法检测外周血RORγt和Foxp3 mRNA的表达、血浆白细胞介素6（IL-6）、IL-17、IL-10和高敏C反应蛋白（hs-CRP）的浓度及其相关性,并分析Treg细胞与Th17细胞的平衡性变化。结果： 与健康对照组相比,尿毒症组RORγt mRNA表达量、IL-6、IL-17和hs-CRP显著上升（P〈0.05）,而Foxp3 mRNA表达量和IL-6明显下降（P〈0.05）。未接受透析治疗与维持性血液透析患者之间,上述指标无显著差异。同时,RORγt与hs-CRP存在正相关,而Foxp3与hs-CRP存在负相关。结论： Treg细胞与Th17细胞在尿毒症患者体内存在不平衡性,这种不平衡性与尿毒症患者微炎症状态有关。

英文摘要：

AIM： To investigate the changes of T-helper 17（Th17） and regulatory T （Treg） cells in uremic patients by determining the mRNA expression of retinoid-related orphan receptor γt （RORγt）and forkhead box P3 protein （Foxp3）, and to observe the correlation with the status of microinflammation. METHODS： Thirty uremia patients enrolled in our blood purification center during July 2010 to July 2011 were selected in the study and divided into maintaining hemodialysis （MHD） group （n=20） and chronic kidney disease （CKD） group （n=10）. Twenty matched healthy volunteers served as controls. Serum samples were collected from all the patients in the morning. The mRNA expression of RORγt and Foxp3,plasma interleukin （IL）-6, IL-10 and IL-17 in these patients were measured by real-time polymerase chain reaction and enzyme-linked immunosorbent assay. The content of high-sensitivity C-reactive protein （hs-CRP） was detected by immunoturbidimetric assay （ITA）. The relationship between the ratio of Treg/Th17 cells and the status of microinflammation was also analyzed. RESULTS： RORγt mRNA, IL-6 and IL-17 were significantly higher in uremia groups than those in control group （P〈0.05）, while mRNA expression of Foxp3 and the level of plasma IL-10 were significantly lower in uremia group than those in control group （P〈0.05）. The ratio of RORγt/Foxp3 mRMA was higher in uremia group than that in control group （P〈0.05）, and no significant difference between MHD group and CKD group was observed. The concentration of hs-CRP, which was higher than 3 mg/L, was significantly higher in uremia group than that in control group （P〈0.05）. The level of hs-CRP had positive correlation with RORγt, and negative correlation with Foxp3. CONCLUSION： The ratio of Th17 Treg is abnormal in uremia patients. The disequilibrium of Th17 and Treg cells has a close relationship with the status of microinflammation.