腹膜透析患者におけるCD4陽性ヘルパーT細胞(Th1/Th2)バランス

Uremic patients have an impaired immune response that accounts for their susceptibility to infections and resistance to vaccination. Various antigenic stimuli drive T-helper (Th) lymphocytes to differentiate to Th1 or Th2 cells. We investigated the Th subsets in 17 patients receiving continuous ambulatory peritoneal dialysis (CAPD) using a newly developed immunofluorescence staining method for detecting intracellular cytokines using flow cytometric analysis. The Th subsets were simultaneously measured in 15 patients with chronic renal failure (CRF) and 29 healthy controls. Serum interleukin (IL)-10 levels were determined using a commercial enzyme-linked immunoadsorbent assay. The percentage of CD4^+ T cells producing Th1 cytokine (interferon-γ) and Th2 cytokine (IL-4) in the CRF patients was significantly higher than that of the controls. The proportion of Th1 cells did not differ between the CAPD patients and the controls. Unlike Th1 cells, a significantly higher proportion of CD4^+ T cells in the CAPD patients exhibited a Th2-type cytokine secretion pattern, than that of the controls. Serum IL-10 levels in the CAPD patients were also significantly higher than those in the controls. The percentage of Th2 cells and the ultrafiltration volume were negatively correlated. A positive correlation between the percentage of Th2 cells and serum IL-10 levels was observed. These findings suggest that anti-inflammatory activity caused by IL-4 and IL-10 may be associated with the ultrafiltration ability of CAPD patients