Korean Journal of Nephrology 1988;7(2):303-314.

미세변화신증후군 환아에서의 각종 면역지표의 변화

박용훈 , 김정란 , 신정애 , 구자훈

Abstract

A prospective study was conducted to see the changes of various immunologic indices and its significance in minimal change nephrotic syndrome (MCNS). Study population consisted of 51 children with MCNS (7 infre- quent relapser; IR, 38 frequent relapser steroid depen- dent; FR/SD and 6 partial responder; PR), in whom diagnosis was confirmed by percutaneous renal biopsy. Disease activity was divided into 3 stages; stage I- relapse period, stage II-within 30 days of remission and stage III-over 30 days of remission. The following results were obtained: Urinary N-acetyl-b-D-glucosaminidise (nM/min/mg- creatinine) showed elevated levels in stage I (72.7±60.3) and stage II (23.6±16.2) compared with stage III (6.8±4. 8) and control (4.0±+1.6). Urinary neopterin (mmol/mol creatinine) showed in- creased level in stage I (280+20) and stage II (198+22) compared with stage III (167±63) and control (170±36). The total T cell count (%) showed no changes between stages, nor between study group and control. However, T cell subset analysis showed T, cell count (%) lower in stage I (20.4±11.6). And stage II (20.1±7.6) compared with stage III (28.3 ±10.4). The T,/T, ratio was lower in stage I (0.64±0.41) and stage II (0.75± 0.56) compared with stage III (1.58± 1.08), and this lowering of T,/T, ratio was mainly caused by increase of T, cells. The total B cell count (%) showed no changes between stages, nor between study group and control. During relapse period, serum IgG was lower than con- trol (344±248 versus 1.045±300 mg/dl). Serum IgE was also elevated in study patients compared with control (316±350 versus 49±37 mg/dl), and the elevation of IgE was more marked in FR/SD and PR group than IR group (67% versus 25%). In summary, it can be concluded from the present study that intimate relationship exists between MCNS and immune abnormality. The most pronounced changes has been noted in 8 subset and serum IgE, and marked elevation of serum IgM could be used as a predictor for frequent relapse or partial response in MCNS children.