Descamps-Latscha B, Chatenoud L
Nephrology Department, INSERM, Hôpital Necker, Paris, France.
Semin Nephrol. 1996 May;16(3):183-91.
Recent knowledge into the pathophysiological mechanisms mediating the immune abnormalities characteristic of end-stage renal disease (ESRD) has focused on the dual activation versus deficiency state of immunocompetent cells. Despite major advances in renal replacement therapy, notably hemodialysis, no significant improvement in the immune status of uremic patients has been achieved. After a brief review of the role of T cells and B cells in the normal immune response, the functional and phenotypic T and B cell abnormalities observed in uremic patients are presented. Special emphasis is placed on our recent findings indicating that these abnormalities are observed at an early stage in the course of chronic renal failure, worsen with the progression of uremia, and are exacerbated by the dialysis procedure. The previous hypotheses that could reconcile the so-called Janus-faced behavior of T cells in uremia are updated in light of the recent findings obtained in the search of therapeutic strategies that could counteract the impaired responsiveness of patients with ESRD to vaccination against hepatitis B virus. Perspectives of research aimed at elucidating the respective role of T helper cell subpopulations (Th1 and Th2) could contribute to understanding of the mechanisms of the multifaceted process of uremia-related immune dysregulation and of the rationale for possible immunointervention strategies.
近期对于介导终末期肾病（ESRD）特征性免疫异常的病理生理机制的认识，聚焦于免疫活性细胞的双重激活与缺陷状态。尽管肾脏替代治疗取得了重大进展，尤其是血液透析，但尿毒症患者的免疫状态并未得到显著改善。在简要回顾T细胞和B细胞在正常免疫反应中的作用之后，介绍了在尿毒症患者中观察到的功能性和表型性T细胞及B细胞异常。特别强调了我们最近的发现，即这些异常在慢性肾衰竭病程的早期就已出现，随着尿毒症的进展而恶化，并因透析过程而加剧。根据在寻找可抵消ESRD患者对乙肝疫苗接种反应受损的治疗策略过程中获得的最新发现，对之前关于尿毒症中T细胞所谓两面性的假说进行了更新。旨在阐明辅助性T细胞亚群（Th1和Th2）各自作用的研究前景，可能有助于理解尿毒症相关免疫失调多方面过程的机制以及可能的免疫干预策略的原理。
