中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2014年
4期
247-253
,共7页
许嵘%钟一红%丁小强%方艺%卢泽军%张慧%刘少鹏%朱加明
許嶸%鐘一紅%丁小彊%方藝%盧澤軍%張慧%劉少鵬%硃加明
허영%종일홍%정소강%방예%로택군%장혜%류소붕%주가명
红斑狼疮,系统性%狼疮肾炎%T淋巴细胞,调节性%白细胞介素17
紅斑狼瘡,繫統性%狼瘡腎炎%T淋巴細胞,調節性%白細胞介素17
홍반랑창,계통성%랑창신염%T림파세포,조절성%백세포개소17
Lupus erythematosus,systemic%Nephritis,lupus%Treg cell%Th17%IL-17
目的 阐明狼疮肾炎(LN)患者外周血辅助性T细胞17/调节性T细胞(Th17/Treg)及白细胞介素(IL)17与临床病理的相关关系.方法 以2011年6月至2012年2月在复旦大学附属中山医院肾内科就诊的LN患者为研究对象,记录其人口学、临床指标和病理指数等资料.流式细胞术检测外周血Th17、Treg细胞所占比例,计算Th17/Treg比值;ELISA法检测外周血IL-17等细胞因子水平.结果 60例LN患者被纳入研究,SLE疾病活动指数(SLEDAI)为9.50±4.61.LN患者(活动组+非活动组)Th17/Treg比值明显高于健康对照组[(0.95±0.67)比(0.29±0.13),P＜ 0.05];LN活动组Th 17/Treg比值明显高于LN非活动组[(1.33±0.71)比(0.57±0.33),P＜0.01].LN患者外周血Th17/Treg比值与SLEDAI呈正相关(r=0.650,P＜0.01),与肾脏病理活动指数(AI)呈正相关(r=0.675,P＜0.01).血清IL-10水平与SLEDAI呈负相关(r=-0.567,P＜ 0.01),与AI呈负相关(r=-0.422,P＜0.01);血清IL-17水平与SLEDAI呈正相关(r=0.559,P＜ 0.01),与AI呈正相关(r=0.479,P＜0.01);血清IL-23水平与SLEDAI呈正相关(r=0.339,P＜0.05),与AI呈正相关(r=0.350,P＜0.05).LN患者血清抗ds-DNA抗体水平和C3水平与SLEDAI和AI评分均无相关性(P＞0.05).以SLEDAI≥10作为诊断LN临床病情活动标准,Th17/Treg、IL-17和IL-23的ROC曲线下面积分别为0.92(0.83～ 1.00)、0.91(0.81～1.00)和0.67(0.51 ～ 0.83);以AI＞8分作为诊断LN病理活动标准,Th17/Treg和IL-17的ROC曲线下面积分别为0.87(0.76～ 0.99)和0.84(0.69～ 0.99).结论 外周血Th17/Treg比值和IL-17水平与LN患者临床病理活动的相关度高于血清抗ds-DNA抗体、C3及IL-10、IL-23等指标;血清IL-10、IL-23水平与LN临床病理的相关度高于血清抗ds-DNA抗体和C3.
目的 闡明狼瘡腎炎(LN)患者外週血輔助性T細胞17/調節性T細胞(Th17/Treg)及白細胞介素(IL)17與臨床病理的相關關繫.方法 以2011年6月至2012年2月在複旦大學附屬中山醫院腎內科就診的LN患者為研究對象,記錄其人口學、臨床指標和病理指數等資料.流式細胞術檢測外週血Th17、Treg細胞所佔比例,計算Th17/Treg比值;ELISA法檢測外週血IL-17等細胞因子水平.結果 60例LN患者被納入研究,SLE疾病活動指數(SLEDAI)為9.50±4.61.LN患者(活動組+非活動組)Th17/Treg比值明顯高于健康對照組[(0.95±0.67)比(0.29±0.13),P＜ 0.05];LN活動組Th 17/Treg比值明顯高于LN非活動組[(1.33±0.71)比(0.57±0.33),P＜0.01].LN患者外週血Th17/Treg比值與SLEDAI呈正相關(r=0.650,P＜0.01),與腎髒病理活動指數(AI)呈正相關(r=0.675,P＜0.01).血清IL-10水平與SLEDAI呈負相關(r=-0.567,P＜ 0.01),與AI呈負相關(r=-0.422,P＜0.01);血清IL-17水平與SLEDAI呈正相關(r=0.559,P＜ 0.01),與AI呈正相關(r=0.479,P＜0.01);血清IL-23水平與SLEDAI呈正相關(r=0.339,P＜0.05),與AI呈正相關(r=0.350,P＜0.05).LN患者血清抗ds-DNA抗體水平和C3水平與SLEDAI和AI評分均無相關性(P＞0.05).以SLEDAI≥10作為診斷LN臨床病情活動標準,Th17/Treg、IL-17和IL-23的ROC麯線下麵積分彆為0.92(0.83～ 1.00)、0.91(0.81～1.00)和0.67(0.51 ～ 0.83);以AI＞8分作為診斷LN病理活動標準,Th17/Treg和IL-17的ROC麯線下麵積分彆為0.87(0.76～ 0.99)和0.84(0.69～ 0.99).結論 外週血Th17/Treg比值和IL-17水平與LN患者臨床病理活動的相關度高于血清抗ds-DNA抗體、C3及IL-10、IL-23等指標;血清IL-10、IL-23水平與LN臨床病理的相關度高于血清抗ds-DNA抗體和C3.
목적 천명랑창신염(LN)환자외주혈보조성T세포17/조절성T세포(Th17/Treg)급백세포개소(IL)17여림상병리적상관관계.방법 이2011년6월지2012년2월재복단대학부속중산의원신내과취진적LN환자위연구대상,기록기인구학、림상지표화병리지수등자료.류식세포술검측외주혈Th17、Treg세포소점비례,계산Th17/Treg비치;ELISA법검측외주혈IL-17등세포인자수평.결과 60례LN환자피납입연구,SLE질병활동지수(SLEDAI)위9.50±4.61.LN환자(활동조+비활동조)Th17/Treg비치명현고우건강대조조[(0.95±0.67)비(0.29±0.13),P＜ 0.05];LN활동조Th 17/Treg비치명현고우LN비활동조[(1.33±0.71)비(0.57±0.33),P＜0.01].LN환자외주혈Th17/Treg비치여SLEDAI정정상관(r=0.650,P＜0.01),여신장병리활동지수(AI)정정상관(r=0.675,P＜0.01).혈청IL-10수평여SLEDAI정부상관(r=-0.567,P＜ 0.01),여AI정부상관(r=-0.422,P＜0.01);혈청IL-17수평여SLEDAI정정상관(r=0.559,P＜ 0.01),여AI정정상관(r=0.479,P＜0.01);혈청IL-23수평여SLEDAI정정상관(r=0.339,P＜0.05),여AI정정상관(r=0.350,P＜0.05).LN환자혈청항ds-DNA항체수평화C3수평여SLEDAI화AI평분균무상관성(P＞0.05).이SLEDAI≥10작위진단LN림상병정활동표준,Th17/Treg、IL-17화IL-23적ROC곡선하면적분별위0.92(0.83～ 1.00)、0.91(0.81～1.00)화0.67(0.51 ～ 0.83);이AI＞8분작위진단LN병리활동표준,Th17/Treg화IL-17적ROC곡선하면적분별위0.87(0.76～ 0.99)화0.84(0.69～ 0.99).결론 외주혈Th17/Treg비치화IL-17수평여LN환자림상병리활동적상관도고우혈청항ds-DNA항체、C3급IL-10、IL-23등지표;혈청IL-10、IL-23수평여LN림상병리적상관도고우혈청항ds-DNA항체화C3.
Objective To explore the correlation of Th17/Treg ratio and related cytok(ui）es with clinical and pathological activity in patients with lupus nephritis (LN).Methods The patients with lupus nephritis were enrolled into this study from June 2011 to Feb 2012.The demographic data,clinical activity and pathological index were recorded and analyzed in details.The frequency of Th17 and Treg in peripheral blood CD4+ T lymphocytes was tested by flow cytometry and the ratio of Th17 to Treg was calculated.The levels of such cytokines as IL-6,IL-10,IL-17,IL-23,TGF-β1 were detected by ELISA.Results A total of 60 patients with LN were enrolled in this study.Of them,90％ were female,10％ were male,the average age was (36.39±14.23) (14-75) years old,the duration was 1.00(0.33-9.25) years,the average SLEDAI was (9.50±4.61).Compared with control group,the ratio of Th17 to Treg in LN group was significantly higher [(0.95±0.67) vs (0.29±0.13),P ＜ 0.05]; further the Th17/Treg ratio in active LN group was much higher [(1.33±0.71) vs (0.57±0.33),P ＜ 0.01] compared with inactive LN group.The ration of Th17 to Treg was positively correlated with SLEDAI and AI (r =0.650,P ＜ 0.01; r =0.675,P ＜ 0.01).The level of serum IL-10 was negatively correlated with SLEDAI and AI (r =-0.567,P ＜ 0.01; r =-0.422,P ＜ 0.01).The level of serum IL-17 was positively correlated with SLEDAI and AI (r =0.559,P ＜ 0.01; r =0.479,P ＜ 0.01).The level of IL-23 was positively correlated with SLEDAI and AI (r =0.339,P ＜ 0.05; r =0.350,P ＜ 0.05).The levels of serum anti-dsDNA and C3 were not correlated with SLEDAI and AI in patients with LN (P ＜ 0.01).As the diagnostic indicator of active LN(SLEDAI≥ 10),the AUCs of Th17/Treg,IL-17,IL-23 were 0.92 (0.83-1.00),0.91 (0.81-1.00) and 0.67(0.51-0.83),respectively.As the diagnostic marker of AI ＞ 8,the AUCs of Th17/Treg and IL-17 were 0.87(0.76-0.99) and 0.84 (0.69-0.99).Conclusions The ratio of Th17 to Treg and the level of serum IL-17 are good indicator for evaluating both clinical and pathological activity in patients with LN.The levels of IL-10 and IL-23 show better correlation with SLEDAI and AI than the traditional indicator anti-dsDNA and C3.
