Sumary of the Thesis Study on Cell Mediated Immunity of Chronio Hemodialysis Patients

Abstract

It has bog been pointed out that many blood dialysis patints suffer from immunologioal Pificiency. However, the reports on its context do not always agree. In fact, there are m any problems in the day dealinge with dialysis patients such as a high tuberculosis controtion r ate, many toxins infection cases, fast development in cases of infection and a high rate of malig n ant tumor outbreak. This fndicates the reduced functions of the host defence mechanism against infection. The main cause of this will be the reduced immunological response of the hos t. For this reason, the author examined various kinds of immunity factors, especiailly cell mediated im munity, in order to study the immunity conditions of ohronis cases.
(Object and Method of Stndy)
About 50 cases of chron i c renal failure who had undergone blood dialysis for a period of time were chosen as the subjects. Five to eight healthy peopie were also used to compare the results.
Following tests were undertaken;
1) Measurement of lymphocytes s ubpopulation by cell surface marker.
2) Lymphocyte blastogenesis of peripheral blood by mitogen. (PHA)
3) Target cell lesion test. Anti dependent cel l m ediated cytotoxicity. (ADCC)
4) Delayed type hypersensitivity skin reaction. a) Delayed type hypersensity react ion by recall antigen. (PPD)b) Delayed type hypersensitivity reaction by DNCB.
5) Non-specific skin reaction. (PHA skin reaction)
(Results and Discussion)
The number o flymphoytes of the patients were 1343 ± 564/mm³ which was consideralby lower than that of the healthy subjects 2494 ± 271/mm³. (P <0.001) As for the distribution of the lymphocytes subpopulation, T cell percentage was high and B cell percentage was low.
Lymphocyte blastogenesis by PHA tended to be lower with the patients' group.
The K cell ratio was markedly lower than that of the healthy subjects, but no relations were observed with the period of dialysis. The delayed type hypersensitivity reaction by PPD was low with dialysis patients, whioh indicates the weakening of theif oellular immunity ability. Also, once or twice a year of continuous tests proved the increase of reaction each year.
The result of DNCB sensitization clearly showed the reduced cellular immunity abilyty of diality of dialysis patients. The chance of natural recurrence was obviously higher among the patients who had undergone the dialysis over five years. This suggests the possibilit yof immunity improvement by dialysis.
The PHA hypo dermic test proves generally low among the patients. However, detailed study of the cases shows that although the decrease after two or three yesrs of dialysis, the tendancy increases again with the cases of experience with dialysis over five years. The results of the PHA underskin tests showed a certain degree of relationship with DNCB reaction and PPD reaction.
(Conclusion) The results of thg above-mentinoed tests show that the cellular lmmunity of chronic dialysis patients is considerably low at the initial stage of dialysis introduction; however, it improves to a certain degree after five years of treatment. This suggests the possibility of immunity improvement due to the eradication of uremic toxins by dialsis on the assumption that uremic toxins are the cause for cellular immunnity decrease with chronic dialysis patients.