原发性干燥综合征患者血清可溶性程序性死亡配体1的表达及临床意义

目的：检测原发性干燥综合征（primary Sjogren's syndrome, pSS）患者血清可溶性程序性死亡配体1（sPD-L1）分子的表达,并探讨其临床意义。方法收集61例pSS患者外周血标本,采用ELISA法检测pSS患者及健康对照血清sPD-L1的表达,比较13例初诊pSS患者治疗前后血清sPD-L1表达水平变化,分析其临床意义。结果与健康对照相比,pSS患者血清sPD-L1表达显著升高（0.705±0.051 ng/mL vs 0.366±0.021 ng/mL,P＜0.0001）;pSS患者血清sPD-L1表达水平与ANA滴度、RF、ESR、抗ds-DNA呈正相关（P＜0.05）;活动期的pSS患者血清sPD-L1的表达高于非活动期患者（0.788±0.086 ng/mL vs 0.559±0.042 ng/mL,P=0.022）;伴发多系统损伤pSS患者血清sPD-L1的表达显著高于单纯外分泌腺损伤患者（0.863±0.114 ng/mL vs 0.630±0.114 ng/mL,P=0.022）。治疗后sPD-L1分子的表达无显著变化。结论 pSS患者血清sPD-L1异常高表达,且与疾病活动度、组织损伤密切相关。提示sPD-L1信号可能参与pSS免疫病理进程。     

OX40和OX40L在原发性干燥综合征患者外周血中的表达及临床意义

目的 检测原发性干燥综合征(pSS)患者外周血单个核细胞表面共刺激分子OX40和OX40L的表达,并探讨其临床意义.方法 采用免疫荧光标记流式细胞技术检测51例pSS患者及36例健康志愿者外周血T细胞表面OX40的表达及CD14+单核细胞和CD19+B细胞表面OX40L分子表达,比较11例初诊pSS患者治疗前后OX40和OX40L表达水平变化,分析其临床意义.结果 与健康志愿者相比,pSS患者外周血CD4+T细胞表面OX40表达显著增高(8.65％ ±3.51％ vs 5.68％ ±1.68％,P＜0.01),而CD8+T细胞表面OX40的表达无统计学差异.pSS患者表面OX40L的表达,在外周血中CD14+单核细胞(6.76％±3.60％ vs 3.15％±1.89％,P＜0.01)和CD19+B细胞(4.69％ ±2.40％ vs 2.76％ ±1.33％,P＜0.01)中均高于健康志愿者.活动期的pSS患者外周血OX40和OX40L的表达高于非活动期患者,伴发多系统损伤pSS患者外周血OX40和OX40L分子的表达显著高于单纯外分泌腺损伤患者.治疗后CD4+T细胞表面OX40的表达及CD14+单核细胞和CD19+B细胞表面OX40L的表达显著下降.结论 pSS患者外周血单个核细胞表面OX40和OX40L异常高表达,且与疾病活动度、组织损伤及治疗密切相关.     

可溶性和膜型B7-H3在类风湿关节炎患者外周血中的表达及临床意义

本实验通过检测类风湿关节炎(RA)患者外周血中可溶性B7-H3(sB7-H3)和膜型B7-H3(mB7-H3)的表达及异构体的分布,探讨该分子的异常表达在RA发病中的临床意义。通过收集RA早期患者和健康对照外周血,ELISA方法检测血清中sB7-H3的表达,统计学分析sB7-H3的表达与临床的相关性;同时分离RA患者和健康对照外周血单个核细胞(periph-eral blood mononuclear cells,PBMC),通过流式细胞术检测CD14+的单核细胞膜型B7-H3的变化;通过PCR检测外周血mRNA水平B7-H3两种异构体的表达。结果显示RA患者血清中的sB7-H3分子明显低于健康对照组,RA活动期患者sB7-H3明显低于缓解期患者,并与RA患者肿胀关节数呈负相关;RA患者外周血单核细胞上mB7-H3的表达明显高于健康对照者,RA患者PBMC在mRNA水平B7-H3明显高于健康对照者,主要表达形式为4IgB7-H3。本研究发现膜型和可溶性B7-H3在类风湿性关节炎外周血中异常表达,其可能参与了RA自身免疫性病理的调节。     

系统性红斑狼疮血液系统损害与疾病预后分析

目的 分析系统性红斑狼疮(SLE)血液系统损害与疾病活动情况、免疫学指标的异常及疾病预后相关性.方法 总结江苏省1999-2009年间首次住院SLE患者的临床及实验室资料,观察血液系统损害情况,并分析了血液系统损害与SLE疾病活动情况、免疫学指标及SLE患者病死率间的关系.统计学处理采用X2检验.结果 1958例SLE患者纳入研究范围,其中女性患者1836例,男性患者122 例.所有SLE患者中,1549例(79.1%)患者合并血液系统损害,其中贫血占62.3%,白细胞减少占45.5%,血小板减少占29.4%;轻、中、重度活动组患者血液学损害率均高于基本无活动组(P=0.01和P＜0.01);血液系统损害发生率在红细胞沉降率、补体C3、抗双链DNA(dsDNA)抗体阳性组高于阴性组(P＜0.01);有166例患者在随访中死亡,其中因重症感染死亡占38.6%,因肾功能衰竭死亡占22.9%,因神经系统损害死亡占15.1%,心血管疾病占10.2%,其他死因占13.3%.死亡病例中存在血液系统损害占91.6%,无血液系统损害占8.4%,血液系统损害率在死亡患者中明显增高(p＜0.01).结论 血液系统是SLE最常受累的系统之一,其中以贫血最为常见,血液系统损害与狼疮病情活动密切相关;免疫性指标异常的患者容易继发血液系统的损害;重症感染是SLE患者死亡的主要原因,存在血液系统损害的SLE患者病死率高于非血液系统损害的SLE患者.

Abstract：

Objective To explore the relationship between the impairment of hematological system and disease activity,immunological parameters,and the prognosis of systemic lupus erythematosus (SLE).Methods The clinical and laboratory data of in-patients with SLE in Jiangsu Province were investigated and all patients were hospitalized between 1999-2009.The impairment of hematological system was assessed and the relationship between hematological system damage and disease activity,immunological parameters,mortality rate of patients with SLE were analyzed.Statistic method used was X2 test.Results One thousand nine hundred and fifty eight cases of SLE were included in the study,in which,1836 were female and 122 were male.One thousand five hundred and forty nine (79.1%) patients complicated with hematological system damage,62.3% were anemia,45.5% with leucopenia and 29.4% with thrombocytopenia.There were significant differences in hematological system damage rate among patients with mild activity group,moderate activity group,severe activity group and almost no activity group,compared respectively with almost no activity group.The P values were P=0.01 and P＜0.01 respectively.The incidence of hematological system damage in elevated ESR,low complement C3 level,anti-dsDNA antibody group was higher than that in patients who had normal ESR,complement C3 level and anti-dsDNA group.(P＜0.01).During follow-up,166 patients died,of which the mortality rate(91.6%) in patients had hematological system damage,was obviously higher than those without hematological damage(8.4%)(P＜0.01 ).Among the 166 deceased patients,38.6% died of severe infection,22.9% died ofrenal failure,15.1% died ofnervous system damage,10.2% died of cadiovascular damage and 13.3% died from other causes.Conclusion Hematological system is one of the most commonly involved system in patients with SLE,of which anemia is the most common,and the incidence of leukopenia follows.The impairment of hematological system is closely related to lupus activity.Patients with abnormal immune parameters tend to have secondary hematological system damage.Severe infection is the main cause of death in patients with lupus,followed by nervous system damage and kidney damage.The mortality rate in patients with lupus that complicated hematological system damage is higher than patients who have no hematological system damage.     

补肾安胎方调节胚泡着床障碍小鼠雌、孕激素的实验研究

目的观察补肾安胎方对着床障碍小鼠妊娠率和着床点数的影响.方法将妊娠小鼠随机分为3组,于妊娠第1天正常组和模型组灌胃自来水,中药组灌胃补肾安胎方;于妊娠第3、4天每天2次正常组皮下注射溶剂,模型组和中药组分别注射吲哚美辛（4.33 mg/kg）造成小鼠胚泡着床障碍的动物模型,妊娠第5、8天留取血清;采用放免法检测3组小鼠雌、孕激素含量;妊娠第8天观察比较3组小鼠妊娠率、妊娠小鼠着床点数;采用免疫组化技术检测子宫雌、孕激素受体表达水平.结果（1）小鼠妊娠率和胚泡着床点数：模型组（27.3%、5.3±0.7）显著低于正常组（90.9%、13.3±2.8,P＜0.01）,中药组（72.7%、10.7±2.2）较模型组显著增高（P＜0.05）.（2）血清雌激素水平：妊娠第5、8天时中药组均高于模型组（P＜0.05或P＜0.01）,第8天时高于正常组（P＜0.01）.（3）血清孕激素水平：妊娠第5、8天时模型组、中药组均低于正常组（P＜0.05或P＜0.01）,但第8天中药组显著高于模型组（P＜0.01）.（4）免疫组织化学结果：中药组雌、孕激素受体表达显著高于模型组.结论补肾安胎方能提高吲哚美辛诱导着床障碍小鼠妊娠率和着床点数,其机制可能与该方能改善甾体激素水平,促进子宫内膜雌、孕激素受体的表达有关.