Alhamawi Renad M, Shafea Basmah Y, Bakhsh Halah H, Fayraq Layal A, Aloufi Samar T, Alharbi Taraf F, Alharbi Abdullah A, Alharbi Abdulaziz A, Alanize Bashar F, Bakhsh Abdulaziz M, Rajih Emad S, Sandokji Ibrahim A, Mahallawi Waleed H
Clinical Laboratory Sciences Department, College of Applied Medical Sciences, Taibah University, Madinah 42353, Saudi Arabia.
General and Specialized Surgery Department, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia.
J Clin Med. 2025 Sep 17;14(18):6533. doi: 10.3390/jcm14186533.
: End-stage renal disease (ESRD) is a growing global health concern, and hemodialysis (HD) remains the most common life-sustaining therapy for patients with advanced kidney failure. Both humoral and cellular immunity are impaired post hemodialysis, leading to immune system dysfunction. : We utilized flow cytometry to quantify cell populations based on surface markers, including CD3 (total T lymphocytes), CD4 (helper T-cells), CD8 (cytotoxic T-cells), CD19 (B lymphocytes), and CD16/CD56 (natural killer (NK) cells). EDTA-blood samples were collected intravenously immediately before and after dialysis. : A consistent decline in CD3 T lymphocytes was observed post hemodialysis. This reduction occurred across both male and female cohorts: = 0.0342 and = 0.0002, respectively. CD8 cytotoxic T-cells decreased significantly post HD, = 0.0003. Conversely, CD4 helper T-cells exhibited a paradoxical increase, = 0.0321. The divergent trends in CD4 and CD8 cells led to a statistically significant increase in the CD4/CD8 ratio post dialysis, = 0.0005. Notably, stratification by gender uncovered that the post-HD changes in CD4 and CD8 T-cells were exclusive to female patients. Females demonstrated a pronounced increase in CD4 cells and a sharper decline in CD8 cells compared to males. CD19 B lymphocytes showed a statistically significant decline post hemodialysis ( < 0.0001). While both genders exhibited reduced B-cell percentages, female patients experienced a more pronounced reduction than males. NK cells were severely depleted post dialysis in both male and female cohorts. : Overall, the immune alterations observed in HD patients, including T-cell reduction, B-cell lymphopenia, and changes in NK cell populations, contribute to the increased risk of infections, malignancy, and cardiovascular disease in this population.
终末期肾病（ESRD）是一个日益受到全球关注的健康问题，血液透析（HD）仍然是晚期肾衰竭患者最常见的维持生命的治疗方法。血液透析后体液免疫和细胞免疫均受损，导致免疫系统功能障碍。
我们利用流式细胞术根据表面标志物对细胞群体进行定量，这些标志物包括CD3（总T淋巴细胞）、CD4（辅助性T细胞）、CD8（细胞毒性T细胞）、CD19（B淋巴细胞）和CD16/CD56（自然杀伤（NK）细胞）。在透析前和透析后立即静脉采集乙二胺四乙酸（EDTA）抗凝血样本。
血液透析后观察到CD3 T淋巴细胞持续下降。这种减少在男性和女性队列中均有发生：分别为P = 0.0342和P = 0.0002。HD后CD8细胞毒性T细胞显著减少，P = 0.0003。相反，CD4辅助性T细胞呈现出反常的增加，P = 0.0321。CD4和CD8细胞的不同趋势导致透析后CD4/CD8比值有统计学显著增加，P = 0.0005。值得注意的是，按性别分层发现，HD后CD4和CD8 T细胞的变化仅见于女性患者。与男性相比，女性的CD4细胞显著增加，CD8细胞下降更明显。血液透析后CD19 B淋巴细胞有统计学显著下降（P < 0.0001）。虽然两性的B细胞百分比均降低，但女性患者的降低更为明显。透析后男性和女性队列中的NK细胞均严重耗竭。
总体而言，HD患者中观察到的免疫改变，包括T细胞减少、B细胞淋巴细胞减少和NK细胞群体变化，导致该人群感染、恶性肿瘤和心血管疾病风险增加。
