血栓与止血学
血栓與止血學
혈전여지혈학
CHINESE JOURNAL OF THROMBOSIS AND HEMOSTASIS
2014年
3期
121-125
,共5页
顾蔚%徐开林%林传明%张育%孙梅%何斌%王方方%裴孝平%陈沛帅%谢晓燕%沈连军%顾键
顧蔚%徐開林%林傳明%張育%孫梅%何斌%王方方%裴孝平%陳沛帥%謝曉燕%瀋連軍%顧鍵
고위%서개림%림전명%장육%손매%하빈%왕방방%배효평%진패수%사효연%침련군%고건
利妥昔单抗%UC-MSC%系统性红斑狼疮%易栓症%靶向治疗
利妥昔單抗%UC-MSC%繫統性紅斑狼瘡%易栓癥%靶嚮治療
리타석단항%UC-MSC%계통성홍반랑창%역전증%파향치료
Rituximab%UC-MSC%Systemic lupus erythematosus%Hypercoagulable state%Targe-ted therapy
目的：初步探讨脐带间充质干细胞（ umbilical cord mesenchymal stem cells ，UC-MSC）联合利妥昔单抗（ rit-uximab，美罗华）与甲强龙对系统性红斑狼疮（ systemic lupus erythematosus ，SLE）患者免疫炎性易栓状态的干预作用。方法8例SLE患者经肾活检确诊为狼疮性肾炎。予SLE 活动指数（ SLEDAI 积分）评价病情活动程度；流式细胞术（FCM）监测B细胞清除、T细胞亚群及炎症介质表达水平；酶联免疫吸附法（ELISA）检测抗心磷脂抗体（ACA）、狼疮抗凝物（ LA）水平；以磁珠法检测血凝常规、血浆D二聚体（ D-D）、抗凝血酶（ AT）等。结果随访第1个月临床症状明显改善，CD19和CD20降至“0”；至第3个月全组SLEDAI评分＜4分，Th1（IFN-γ）、Th2（IL-4）及CD11b、CD25水平均接近正常；随访至1年上述指标维持在正常值内。结论利妥昔单抗联合UC-MSC所具有的靶向作用，能有效清除外周血致病性B细胞，恢复Th1/Th2免疫平衡状态，减少炎症因子释放，促进机体免疫重建，恢复凝血-抗凝系统平衡，从而改善机体免疫炎性易栓状态。
目的：初步探討臍帶間充質榦細胞（ umbilical cord mesenchymal stem cells ，UC-MSC）聯閤利妥昔單抗（ rit-uximab，美囉華）與甲彊龍對繫統性紅斑狼瘡（ systemic lupus erythematosus ，SLE）患者免疫炎性易栓狀態的榦預作用。方法8例SLE患者經腎活檢確診為狼瘡性腎炎。予SLE 活動指數（ SLEDAI 積分）評價病情活動程度；流式細胞術（FCM）鑑測B細胞清除、T細胞亞群及炎癥介質錶達水平；酶聯免疫吸附法（ELISA）檢測抗心燐脂抗體（ACA）、狼瘡抗凝物（ LA）水平；以磁珠法檢測血凝常規、血漿D二聚體（ D-D）、抗凝血酶（ AT）等。結果隨訪第1箇月臨床癥狀明顯改善，CD19和CD20降至“0”；至第3箇月全組SLEDAI評分＜4分，Th1（IFN-γ）、Th2（IL-4）及CD11b、CD25水平均接近正常；隨訪至1年上述指標維持在正常值內。結論利妥昔單抗聯閤UC-MSC所具有的靶嚮作用，能有效清除外週血緻病性B細胞，恢複Th1/Th2免疫平衡狀態，減少炎癥因子釋放，促進機體免疫重建，恢複凝血-抗凝繫統平衡，從而改善機體免疫炎性易栓狀態。
목적：초보탐토제대간충질간세포（ umbilical cord mesenchymal stem cells ，UC-MSC）연합리타석단항（ rit-uximab，미라화）여갑강룡대계통성홍반랑창（ systemic lupus erythematosus ，SLE）환자면역염성역전상태적간예작용。방법8례SLE환자경신활검학진위랑창성신염。여SLE 활동지수（ SLEDAI 적분）평개병정활동정도；류식세포술（FCM）감측B세포청제、T세포아군급염증개질표체수평；매련면역흡부법（ELISA）검측항심린지항체（ACA）、랑창항응물（ LA）수평；이자주법검측혈응상규、혈장D이취체（ D-D）、항응혈매（ AT）등。결과수방제1개월림상증상명현개선，CD19화CD20강지“0”；지제3개월전조SLEDAI평분＜4분，Th1（IFN-γ）、Th2（IL-4）급CD11b、CD25수평균접근정상；수방지1년상술지표유지재정상치내。결론리타석단항연합UC-MSC소구유적파향작용，능유효청제외주혈치병성B세포，회복Th1/Th2면역평형상태，감소염증인자석방，촉진궤체면역중건，회복응혈-항응계통평형，종이개선궤체면역염성역전상태。
Objective To investigate the therapeutic role of rituximab combined with umbilical cord mesenchymal stem cells ( UC-MSC) on immune hypercoagulable state of the patients with systemic lupus ery-thematosus(SLE).Methods The eight patients with lupus nephritis (LN) who were confirmed by biopsy. The degree of SLE severity was evaluated by the systemic lupus erythematosus disease activity index ( SLE-DAI).The level of B cell and T cell subsets were detected by flow cytometry ( FCM).The level of ACA ( IgG/M/A ) , LA and inflammatory factors in plasma was detected by enzyme-linked immunosorbent assay ( ELISA).The level of D-D, AT-Ⅲand conventional coagulation were detected by automatic coagulometer.Results After the treatment, the patients improved within 1 month.The percent of CD19 and CD20 reduced to 0.00%.The SLEDAI of all patients were less than 4 after 3 months, the level of CD11b,CD25,Th1( IFN-γ) and Th2(IL-4)was significantly reduced.After one year, the level of CD19,CD20 and CD11b,CD25, Th1 ( IFN-γ) , Th2 ( IL-4 ) was within the normal range.Conclusion Rituximab combined with UC-MSC which is a targeted therapy to improve the immune hypercoagulable state by removing B cells , balancing the Th1/Th2 and reducing the production of inflammatory cytokines.
