系统性红斑狼疮患者外周血CD4+CXCR5+滤泡辅助性T细胞样细胞的变化及糖皮质激素对其的影响

Objective To investigate the frequencies of CD4+CXCR5+T cells in the CD4+T cells of peripheral blood of patients with systemic lupus erythematosus (SLE) and the effect of glucocorticoid on it.Methods Frequencies of CD4+CXCR5+T cell were analyzed by flow cytometry in 45 active,20 inactive SLE patients and 20 healthy controls.Differences between groups and the effect of glucocorticoid were analyzed.Meanwhile, the expression of CXCR5 on CDI9+B cells was analyzed. Independent sample t test was used for statistical analysis between twogroups, ANOVA was applied for data analysis between 3 groups,,nonparameterical Spearman's analysis was used for correlation analysis and repeated measurement ANOVA were used to compare the parameters before and after treatment. Results The percentage of CD4+CXCR5+ in CD4+T cells was increased in patients with SLE compared with healthy controls[(16±7)% vs (12±3)%, P＜0.01].It was increased in patients with active SLE [(18±7)%] compared with healthy controls (P＜0.05) but there was no significant difference between inactive SLE[(11±4)%] and healthy controls(P＞0.05). The percentage in patients with LN was higher than that in patients without LN, but without significant difference[(18±7)%vs (14±7)%, P=0.05 ]. The percentage of CD4+CXCR5+T cells was positively correlated with SLEDAI,the titer of ANA and level of ESR but negatively correlated with the level of C3 (P<0.05 for each).No correlation was found between duration and the levels of CRP and immunoglobulin.. The percentage in patients with high anti-dsDNA group was also higher than that of the low group, but no differences were found between anti-Sm antibody positive and negative groups neither between anti-SSA/SSB antibody positive and negative groups(P＞0.05 for each).The expression level of CXCR5 on CD19+B cells in active SLE patients was lower than that of healthy controls[(85±11)% vs (94±3)%, P＜0.05 ]. The percentages of CD4+CXCR5+T cells in 10 untreated active SLE patients were decreased at day 1,day 3 and day 7 after being treated with dexamethasone (20mg/d) when compared with those before the treatment (P＜0.05 for each), but the percentages of CD19+CXCR5+B cells had no significant change (P＞0.05 for each).Conclusion These results demonstrate that the abnormality of CD4+CXCR5+T cells may play an important role in the pathogenesis of SLE.     

川崎病患儿治疗前后血清抵抗素和内脂素的变化

目的 检测急性期川崎病（KD）患儿静脉注射丙种球蛋白（IVIG）治疗前后血清中抵抗素和内脂素含量的变化及意义。方法 选择2011年1月至2013年1月确诊的KD患儿50例为研究对象,同时选取30例健康儿童和30例急性感染性疾病患儿作为对照。酶联免疫吸附法检测KD患儿IVIG治疗前后及对照儿童血清中抵抗素和内脂素的水平。结果 KD患儿血清抵抗素和内脂素含量均明显高于健康对照组和急性感染性疾病患儿（均P<0.05）;经过48 h治疗后,IVIG治疗有效KD患儿血清抵抗素含量较治疗前明显降低（P<0.05）,内脂素含量在IVIG治疗有效KD患儿治疗前后差异无统计学意义（P >0.05）;IVIG治疗无效KD患儿（n=12）治疗前血清抵抗素水平明显高于IVIG治疗有效组（n=38,P<0.05）,而内脂素含量在两组患儿治疗前差异无统计学意义（P >0.05）;KD合并冠脉损害与非冠脉损害患儿的抵抗素和内脂素水平差异均无统计学意义（P >0.05）。结论 KD患儿血清中高表达的抵抗素和内脂素可能参与了KD的发生和发展;血清抵抗素含量可能成为临床观察IVIG治疗效果的新监测指标。     

共刺激分子B7-H4与自身免疫病

T细胞激活需要两种信号途径:一种是通过T细胞表面受体(TCR)-人类主要组织相容性复合体(MHC)-肽复合物特异性抗原信号,第二种是通过抗原提呈细胞(APC)表面分子提供的共刺激信号.后者需要共刺激分子的参与,B7家族就是这一类分子,包括B7-H1、B7-H2、B7-H3、B7-DC和B7-H4.B7类分子主要与T细胞表面相应受体结合,在抗原特异性免疫应答过程中发挥正向或负向调控作用[1].     

类风湿关节炎患者骨密度及骨矿物质含量的变化及意义

目的探讨类风湿关节炎(RA)患者骨密度(BMD)及骨矿物质(BMC)含量的变化及意义。方法选择71例RA患者(RA组)及20例正常人(对照组),采用双能X线骨密度仪检测各组前臂BMD、BMC含量,魏氏法检测血沉(ESR),免疫比浊法检测血清C反应蛋白(CRP),速率散射比浊法检测类风湿因子(RF),ELISA法检测抗环瓜氨酸肽抗体(ACCP);同时进行X线分期,计算患者疾病活动分数(DAS28)。结果 RA组前臂BMD、BMC均低于对照组(P均<0.01),ESR、CRP、RF、ACCP均高于对照组(P均<0.01)。Pearson’s相关分析显示,前臂BMD与DAS28、ESR、RF呈负相关(r分别为-0.357、-0.390、-0.255,P<0.05或<0.01),前臂BMC与DAS28、ESR呈负相关(r分别为-0.344、-0.401,P均<0.01)。多元线性回归分析显示,前臂BMD与RF、年龄呈负相关(T分别为-7.544、-3.254,P均<0.01);前臂BMC与DAS28呈负相关(T=-4.44,P<0.01)。RA组中X线分期为Ⅰ期的有15例,其中BMD示骨质疏松6例、骨量减少2例。结论 RA患者BMD、BMC含量明显减少,其含量减少与RA活动密切相关;RF可能是导致RA骨量丢失的危险因素;BMD检测能更早反映RA患者的骨量丢失情况。     

共刺激分子B7-H4与自身免疫病

T细胞激活需要两种信号途径:一种是通过T细胞表面受体(TCR)-人类主要组织相容性复合体(MHC)-肽复合物特异性抗原信号,第二种是通过抗原提呈细胞(APC)表面分子提供的共刺激信号.后者需要共刺激分子的参与,B7家族就是这一类分子,包括B7-H1、B7-H2、B7-H3、B7-DC和B7-H4.B7类分子主要与T细胞表面相应受体结合,在抗原特异性免疫应答过程中发挥正向或负向调控作用[1].     

系统性红斑狼疮患者外周血树突状细胞的变化及意义

目的探讨系统性红斑狼疮(SLE)患者外周血浆细胞树突状细胞(PDC)和髓样树突状细胞的(MDC)的比例以及细胞因子干扰素α(IFN-α)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)的变化及意义。方法选择38例SLE患者(SLE组)、15例健康志愿者(正常对照组)。采用流式细胞术检测PDC、MDC占淋巴细胞的比例,ELISA法检测外周血IFN-α、IL-6、TNF-α水平。结果①SLE组外周血PDC、MDC比例均显著低于正常对照组。②疾病活动期SLE患者外周血PDC比例显著低于稳定期患者;SLE蛋白尿组外周血PDC比例显著低于非蛋白尿组患者;抗ds-DNA阳性组SLE患者外周血PDC比例显著低于抗ds-DNA阴性组。③PDC比例与血沉、SLE疾病活动指数评分呈负相关,与C3呈正相关。④SLE组与正常对照组相比IFN-α、TNF-α、IL-6水平均增高。结论 SLE患者外周血PDC、MDC比例显著降低,且PDC水平与SLE疾病活动及狼疮肾损害有关。     

调节性T细胞表面标记及抑制功能的对比初探

机体是免疫活化与免疫抑制平衡的整体,CD4+调节性T细胞(Tr)是主要负责负性调节的细胞,但是目前关于CD4+Tr细胞特征性的标记仍众说纷纭.转录因子Foxp3是目前公认的Tr细胞的标记,CD4+CD25+Foxp3+T细胞是经典的Tr细胞标记,然而Foxp3定位在细胞内,透膜标记后细胞丧失功能及活性,所以用此群细胞进行功能研究受到限制[1].后来不同的报道表明CD4+CD39+T细胞、CD4+CD73+T细胞以及CD4+CD25+CD127low/-T细胞也高表达Foxp3并具有免疫抑制功能[2-4],但对于各群细胞的特异性并未做比较研究.本研究通过检测正常人外周血中CD4+CD25highT细胞、CD4+CD39+T细胞、CD4+CD73+T细胞、CD4+CD25+CD127low/-T细胞占CD4+T细胞的百分率、Foxp3蛋白的表达及抑制功能试验,寻找更好的Tr细胞表面的特异性标志.     

系统性红斑狼疮患者外周血CD4+CXCR5+滤泡辅助性T细胞样细胞的变化及糖皮质激素对其的影响

目的 研究系统性红斑狼疮(SLE)患者外周血CD4+CXCR5+T细胞占CD4+T细胞百分率以及糖皮质激素对其的影响,探讨其在SLE发病机制中的作用.方法 采用流式细胞术检测45例活动期、20例缓解期SLE患者及20名健康对照外周血中CD4+CXCR5+T细胞占CD4+T细胞的百分率,比较其在各组中的差异及糖皮质激素治疗对其的影响,同时检测各组中CD19+B细胞上CXCR5的表达.2组间比较用独立样本t检验,3组间比较采用多变量方差分析,与临床指标之间的相关性分析采用非参数的Spearman相关分析,治疗前后的差异用重复测量的方差分析.结果 ①SLE患者外周血CD4+CXCR5+T细胞占CD4+T细胞的比例高于健康对照组[(16±7)%与(12±3)%,P＜0.01],其中活动组[(18±7)%]高于健康对照组(P＜0.05),而缓解组[(11±4)%]和健康对照组之间差异无统计学意义(P＜0.05);狼疮肾炎组高于非狼疮肾炎组,但差异无统计学意义[(18±7)%与(14±7)%,P=0.05].②CD4+CXCR5+T细胞百分率与SLE疾病活动指数(SLEDAI)、抗核抗体滴度和红细胞沉降率(ESR)呈正相关,与补体C3呈负相关(P均＜0.05),与C反应蛋白、病程、免疫球蛋白无相关性(P＞0.05).抗双链DNA抗体升高组与正常组之间、抗sm抗体、抗SSMSSB抗体阴性组和阳性组之间差异无统计学意义(P均＞0.05).③活动期SLE患者CD19+B细胞上CXCR5的表达比例低于健康对照组[(85±11)%与(94±3)%,P＜0.05].④10例初发、未接受治疗的活动期患者在接受地塞米松(20 mg/d)治疗后第1、3、7天外周血中CD4+CXCR5+T细胞百分率均低于治疗前(P均＜0.05).治疗前后CD19+CXCR5+B细胞的百分率无变化(P均＞0.05).结论 外周血CD4+CXCR5+滤泡辅助性T细胞样细胞的异常町能参与SLE的发病.

Abstract：

Objective To investigate the frequencies of CD4+CXCR5+T cells in the CD4+T cells of peripheral blood of patients with systemic lupus erythematosus (SLE) and the effect of glucocorticoid on it.Methods Frequencies of CD4+CXCR5+T cell were analyzed by flow cytometry in 45 active,20 inactive SLE patients and 20 healthy controls.Differences between groups and the effect of glucocorticoid were analyzed.Meanwhile, the expression of CXCR5 on CDI9+B cells was analyzed. Independent sample t test was used for statistical analysis between twogroups, ANOVA was applied for data analysis between 3 groups,,nonparameterical Spearman's analysis was used for correlation analysis and repeated measurement ANOVA were used to compare the parameters before and after treatment. Results The percentage of CD4+CXCR5+ in CD4+T cells was increased in patients with SLE compared with healthy controls[(16±7)% vs (12±3)%, P＜0.01].It was increased in patients with active SLE [(18±7)%] compared with healthy controls (P＜0.05) but there was no significant difference between inactive SLE[(11±4)%] and healthy controls(P＞0.05). The percentage in patients with LN was higher than that in patients without LN, but without significant difference[(18±7)%vs (14±7)%, P=0.05 ]. The percentage of CD4+CXCR5+T cells was positively correlated with SLEDAI,the titer of ANA and level of ESR but negatively correlated with the level of C3 (P<0.05 for each).No correlation was found between duration and the levels of CRP and immunoglobulin.. The percentage in patients with high anti-dsDNA group was also higher than that of the low group, but no differences were found between anti-Sm antibody positive and negative groups neither between anti-SSA/SSB antibody positive and negative groups(P＞0.05 for each).The expression level of CXCR5 on CD19+B cells in active SLE patients was lower than that of healthy controls[(85±11)% vs (94±3)%, P＜0.05 ]. The percentages of CD4+CXCR5+T cells in 10 untreated active SLE patients were decreased at day 1,day 3 and day 7 after being treated with dexamethasone (20mg/d) when compared with those before the treatment (P＜0.05 for each), but the percentages of CD19+CXCR5+B cells had no significant change (P＞0.05 for each).Conclusion These results demonstrate that the abnormality of CD4+CXCR5+T cells may play an important role in the pathogenesis of SLE.     

类风湿关节炎患者骨密度与骨代谢指标的临床意义

目的探讨类风湿关节炎(rheumatoid arthritis,RA)患者骨代谢指标、骨密度(bone mineraldensity,BMD)、骨矿物质含量(bone mineral conten,BMC)的变化及临床意义。方法选择2011年3月至2012年7月安徽医科大学附属省立医院风湿免疫科RA患者(RA组)及健康者(对照组),采用双能X线骨密度仪检测各组受试者前臂BMD和BMC含量,检测2组骨钙素(bone gla protein,BGP)、I型胶原交联羧基末端肽(C-terminal telopeptides of type I collagen,CTX)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C reactive protein,CRP)、类风湿因子(rheumatoid factor,RF)和抗环瓜氨酸肽抗体(anti-cyclic citrullinated peptide antibody,抗-CCP)。摄双手X线正位片,进行X线分期,计算患者疾病活动指数(disease activity score 28,DAS28)。结果 RA组患者71例,对照组20例。RA组骨代谢指标CTX和BGP明显高于对照组,差异有统计学意义(均P0.05)。RA组前臂BMD、BMC,均低于对照组的BMD和BMC,差异有统计学意义(均P0.01)。直线相关分析示RA组CTX与BMD和BMC均呈负相关(r=-0.301,P=0.014;r=-0.296,P=0.015);与病程、RF呈正相关(r=0.382,P=0.001;r=0.263,P=0.029);多元线性回归分析显示前臂BMD与RF、年龄呈负相关(r=-7.544、r=-3.254,P均0.01);前臂BMC与DAS28呈负相关(t=-4.440,P0.01);相关分析显示BMD、BMC与X线分期均呈负相关(r=-0.289、r=-0.284,P均0.01),CTX与X线分期成正相关(r=0.333,P=0.005)。结论 RA患者骨代谢呈高转换型骨丢失,骨代谢指标及骨密度、骨矿盐含量可以预测RA患者出现骨破坏;RF可能为RA患者骨破坏的危险因素。