Guillain-Barre综合征患者B淋巴细胞辅助受体CD21表达研究

目的 本研究通过检测Guillain-Barre综合征（GBS）患者外周血B淋巴细胞辅助受体CD21的表达,探讨CD21与GBS及其严重程度之间的关系.方法 利用流式细胞术检测GBS组（36例）和正常对照组（20例）CD21表达,按病程将GBS组分为急性期亚组与恢复期亚组,按病情轻重将GBS组分为轻症组和重症组,并分析CD21与疾病病程和严重程度之间的关系.结果 与正常对照组（45.32±8.92）%比较,GBS组（73.48±7.63）%B淋巴细胞CD21表达显著升高,差异有统计学意义（P〈0.01）.与恢复期GBS组（70.15±10.00）%比较,急性期GBS组（77.58±7.39）%B淋巴细胞CD21表达无明显差异 （P〉0.05）.与轻症GBS组（68.40±4.81%）比较,重症GBS组（75.98±7.90）% B淋巴细胞CD21无明显差异 （P〉0.05）.结论 CD21在GBS患者中表达显著升高,但与病程和病情严重程度无关.     

Guillain-Barré综合征患者电生理分型分析

目的探讨Guillain-Barré综合征（GBS）的电生理学分型及各型间的差异。方法根据电生理检测结果对54例GBS患者作电生理分型,并对各型的临床表现和脑脊液检验结果进行比较分析。结果54例患者中;行电生理检查的有42例,其中脱髓鞘型占19例（45．24％）,轴索型11例（26．19％）,不明确型5例（11．90％）,正常型7例（16．67％）,失神经电位型0例。大部分脱髓鞘型GBS患者多半伴有不同程度的轴索损害。脱髓鞘型与轴索型之间脑脊液蛋白含量及脑脊液异常率之间有明显差异（P均〈0．05）;在前驱感染及F波异常率之间没有差异（P均〉0．05）。结论电生理检查对GBS具有快捷、经济、安全和微创等优点,但目前尚无统一的分型,其对GBS的诊断具有重要的意义。     

Guillain-Barre综合征患者B淋巴细胞辅助受体CD22、CD72表达的研究

目的探讨Gu illain-Barre综合征(GBS)患者外周血B淋巴细胞辅助受体CD22、CD72表达及其与GBS病程和病情的关系。方法 36例GBS患者(GBS组)按病程及病情分为急性期亚组与恢复期亚组和轻症亚组与重症亚组,应用流式细胞术检测外周血B淋巴细胞CD22及CD72蛋白表达,比较CD22与CD72蛋白在不同亚组间的表达;并与正常对照组(20人)比较。结果 B细胞数量GBS组[(606±118)个]较正常对照组[(248±92)个]明显升高,CD72+CD19+阳性细胞率[(62.11±9.14)%]较正常对照组[(69.72±11.42)%]明显降低(均P<0.01);CD22+CD19+阳性细胞率两组间差异无统计学意义。GBS组中,急性期亚组[(682±91)个]B细胞数量较恢复期亚组[(550±111)个]明显升高,CD72+CD19+阳性细胞率急性期亚组[(57.79±7.69)%]较恢复期亚组[(68.14±7.58)%]明显降低(均P<0.01);CD22+CD19+阳性细胞率两亚组间差异无统计学意义;重症亚组[(685±116)个]较轻症亚组B细胞数量[(561±96)个]明显升高(...     

Guillain-Barré综合征患者血清新喋呤变化

目的探讨血清新喋呤与ＧｕｉｌａｉｎＢａｒé综合征（ＧＢＳ）的关系及临床意义。方法采用ＥＬＩＳＡ竞争法，检测ＧＢＳ组（５２例）、健康成人组（７２名）和其他神经疾病组（４６例）的血清新喋呤水平。结果ＧＢＳ患者血清新喋呤水平明显高于两个对照组（Ｐ＜０００１），随着临床症状的恢复，其新喋呤水平明显下降。结论细胞免疫可能参与ＧＢＳ的病理过程，检测血清新喋呤水平可作为判断ＧＢＳ患者细胞免疫功能的一个客观指标。     

Guillain-Barré综合征患者发生呼吸衰竭的预测量表

Guillain-Barre综合征(GBS)患者发生呼吸衰竭的比例大约占20%,此部分患者预后较差。80%患者发生呼吸衰竭在夜间,需紧急行气管插管,延迟插管则可能增加误吸而发生肺炎的风险,预后差[1-3]。如果及早发现可能存在呼吸衰竭者,即可明确患者处理的优先级别,及时将这些患者收入监护室。目前已有两个有关GBS的预测研究,分别为预     

空肠弯曲菌感染与Guillain-Barré综合征

目的研究空肠弯曲菌感染与ＧｕｉｌａｉｎＢａｒé综合征发病的关系。方法用ＥＬＩＳＡ方法检测４０例ＧｕｉｌａｉｎＢａｒé综合征病人的血清和脑脊液中的空肠弯曲菌ＩｇＧ、ＩｇＭ、ＩｇＡ等抗体，并和其他神经系统疾病组以及正常对照组各２０例进行比较。结果ＧｕｉｌａｉｎＢａｒｒé综合征病人组空肠弯曲菌感染率（５０％）高于两个对照组（均为３０％），但差异无显著意义。结论空肠弯曲菌感染是否是ＧｕｉｌａｉｎＢａｒé综合征的重要发病诱因尚有待商榷。     

Guillain-Barré综合征患者临床及脑脊液细胞学特点

目的探讨Guillain-Barré综合征(GBS)患者临床及CSF细胞学特点。方法回顾性分析37例GBS患者的临床资料。结果本组患者急性起病33例,亚急性起病4例。临床表现为四肢无力18例(48.6%),双下肢无力16例(43.2%),四肢麻木21例(56.8%),双侧面神经麻痹12例(32.4%),其他颅神经损害5例(13.5%),呼吸肌麻痹3例(8.1%),全自主神经功能障碍及Fisher综合征各1例(5.4%);变异型GBS 6例(16.2%)。腰穿CSF检查示4例(10.8%)患者压力高,11例(29.7%)细胞计数升高,29例(78.4%)蛋白升高,7例(18.9%)免疫球蛋白升高。34例(91.9%)CSF细胞学检查异常,22例(64.7%)患者表现为激活的淋巴细胞反应,12例(35.3%)以激活的单核细胞反应为主。感觉或运动神经传导异常25例(67.6%),F波或H反射异常33例(89.2%)。32例患者给予丙种球蛋白或血浆置换治疗,5例给予糖皮质激素治疗,均有效。结论 GBS多数表现为四肢对称性麻木、无力,部分为变异型。F波、H反射电生理检查早期异常率高。CSF细胞学检查早期以淋巴细胞反应为主,后期以单核细胞反应为主。     

EGRIS 模型预测 Guillain-Barré综合征患者呼吸衰竭风险的初步研究

目的探讨EGRIS模型对Guillain-Barré综合征(GBS)患者发生呼吸衰竭的预测价值。方法回顾性分析263例GBS患者的临床资料,按住院期间是否发生呼吸衰竭分为两组。绘制EGRIS预测呼吸衰竭的受试者工作曲线分析(ROC),计算曲线下面积(AUC)、最大约登指数时的评分临界值、灵敏度及特异度。结果本组中28例(10.6%)GBS患者发生呼吸衰竭。EGRIS模型显示了极好的预测能力(AUC=0.892, 95%CI:0.835～0.949,P0.05);当EGRIS分值为3.5时约登指数最大,灵敏度为75%,特异度为85.1%。结论 EGRIS评分模型简便易行,能够在GBS早期准确识别发生呼吸衰竭的高危患者。     

Guillain-Barré综合征患者脑脊液蛋白水平与疾病严重性及预后的关系

目的总结Guillain-Barré综合征(GBS)患者CSF蛋白细胞分离现象(AD-CSF)的特点,分析GBS患者CSF蛋白水平与疾病严重性和预后的关系,探讨其临床意义。方法回顾性收集2007年1月至2016年10月在济宁医学院附属医院住院的206例GBS患者的一般临床资料(性别、年龄、前驱感染和电生理分类)、CSF细胞数和蛋白水平、高峰期及12个月后残疾评分(GDS),比较发病后≤7 d、8～14 d、15～21 d、≥22 d患者AD-CSF的阳性率。利用Pearson相关及Spearman相关分析电生理正常组、脱髓鞘型组、轴索型组、不能分型组患者CSF蛋白水平与高峰期及12个月后GDS的关系。结果患者发病第3周时腰穿的AD-CSF阳性率最高(85.7%),与其他时间点相比,差异有统计学意义(均P0.001)。电生理正常组CSF蛋白水平与高峰期GDS呈正相关(r=0.707,P=0.003),与12个月后GDS无相关性;脱髓鞘型组CSF蛋白水平与高峰期及12个月后GDS均呈正相关(r=0.495,P=0.019;r=0.770,P0.001)。回归分析表明,CSF蛋白水平是脱髓鞘型GBS患者高峰期GDS以及12个月后更高GDS的预测因子。结论 GBS患者AD-CSF的阳性率与腰穿的时间密切相关; CSF蛋白水平可作为脱髓鞘型GBS高峰期疾病更重以及预后不良的预测因子。     

急性Guillain-Barré综合征患者外周血单核细胞TNFα及IL-6的变化

目的探讨肿瘤坏死因子α（ＴＮＦα）及白细胞介素６（ＩＬ６）在急性ＧｕｉｌａｉｎＢａｒé综合征（急性ＧＢＳ）免疫病理机制中的作用。方法采用体外细胞培养方法和免疫微量检测技术对急性ＧＢＳ患者外周血单核细胞经大肠杆菌内毒素（ＬＰＳ）诱导后产生ＴＮＦα、ＩＬ６的能力进行研究。结果急性ＧＢＳ患者外周血单核细胞ＴＮＦα、ＩＬ６水平明显增高，与其他神经疾病组和正常对照组比较有显著差异，且与病情有关。结论急性ＧＢＳ患者血单核细胞处于活化状态，自身免疫功能异常，ＴＮＦα、ＩＬ６可能参与了急性ＧＢＳ的免疫病理过程，且与病情的轻重有密切关系。     

T lymphocyte subset abnormalities in peripheral blood from patients with the Guillain-Barré syndrome

T lymphocytes are probably of pathogenic importance in many autoimmune diseases. Recently, deviations of circulating T-helper (CD4⁺) subpopulations have been noticed. Blood samples from 12 patients with Guillain-Barré syndrome (GBS) were studied with flow cytometry during their disease to define circulating T cell populations. The proportion of T-helper cells (CD4⁺) was decreased (mean value 41±15%, P = 0.01) and the proportion of T cytotoxic/suppressor cells (CD8⁺) was increased (35±18%, P = 0.0006) as compared to the control group of healthy blood donors (47±8% and 26±7% respectively). The CD4⁺ population is divided into the helper/inducer (CD4⁺ CD29⁺) and suppressor/inducer (CD4⁺ CD45RA⁺) subsets. which normally are equally distributed (mean values in our control group were 45±15% and 44±15%, respectively). In patients with GBS, the helper/inducer (CD4⁺ CD29⁺) subset was increased (54±10%, P = 0.05) and the suppressor/inducer (CD4⁺ CD45RA⁺) subset was decreased (31±9, P = 0.005) compared to the controls. The proportion of activated HLA-DR-expressing T cells was increased (7±8%, P = 0.005) as compared to control (3±3%). The total proportions of T cells (CD2⁺), B cells (CD19⁺) and natural killer (NK) cells (CD56⁺) were similar in pateints and controls. The CD4⁺ and CD8⁺ populations, as well as the activated HLA-DR⁺ T cells, normalized during the disease course. The derivations within the CD4⁺ population also tended to normalize, but even at follow up after 6–33 (mean 23) months, some abnormalities remained. In conclusion, we confirm previous reports of T cell activation in peripheral blood from patients with GBS. A new finding is the derivation of T helper subpopulations with an increased helper/inducer (CD4⁺ CD29⁺) subset and a decreased suppressor/inducer (CD4⁺ CD45RA⁺) subset, which indicates a possible autoimmune character of GBS.     

Expression of CD5 on B lymphocytes correlates with disease activity in patients with multiple sclerosis

There is growing evidence that implicates B lymphocytes and their products in the pathogenesis of multiple sclerosis (MS). A subpopulation of B lymphocytes expressing the CD5 antigen are involved in several autoimmune disorders through the release of autoantibodies. In this study, we used three-color flow cytometry to examine the expression of CD5 antigen on B lymphocytes from patients with relapsing-remitting MS, and correlated this expression with features of disease activity and circulating levels of autoantibodies against myelin basic protein. CD5 expression on B lymphocytes was significantly higher in patients with active MS when compared to patients with clinically stable MS or those with inflammatory or noninflammatory neurologic disorders. CD5(+) B lymphocytes from patients with active MS correlated significantly with the number of gadolinium-enhancing MRI lesions, and inversely with disease duration. The expression of CD5 on B lymphocytes in MS patients also correlated with circulating levels antibodies against myelin basic protein. Results presented here indicate that clinically active MS is associated with an expanded population of peripheral CD5(+) B lymphocytes.     

趋化因子MIP-1α和MCP-1在吉兰-巴雷综合征患者脑脊液中的表达

目的通过研究MIP-1α和MCP-1在吉兰-巴雷综合征(GBS)患者脑脊液中的表达水平,探讨种其与GBS发病的关系.方法利用双抗体夹心ELISA法测定18例GBS患者和18例非炎症性神经系统疾病患者脑脊液中MIP-1α和MCP-1的浓度.结果GBS患者脑脊液中MIP-1α浓度明显高于对照组(P＜0.01),而MCP-1浓度稍低于对照组(P＜0.05),且MIP-的α水平与脑脊液蛋白含量呈正相关(r=0.84,P＜0.01).结论MIP-1α和MCP-1可能参与GBS的发病,并发挥着不同的免疫调节作用.     

糖皮质激素对多发性硬化患者外周血淋巴细胞CD80和CD4+CD25+T细胞表达的影响

目的探讨糖皮质激素(GC)对多发性硬化(MS)患者外周血淋巴细胞CD80和CD4+CD25+T细胞表达的影响。方法利用流式细胞仪检测21例MS急性期患者GC治疗前后外周血淋巴细胞CD80和CD4+CD25+T细胞阳性率,并与正常对照组比较;比较MS患者治疗前后扩展功能障碍状况量表(EDSS)评分的变化。结果MS患者急性期外周血淋巴细胞CD80的阳性率[(5.031±1.782)%]较正常对照组[(6.436±2.035)%]明显下降(P<0.05),经GC治疗后CD80的阳性率[(6.467±1.882)%]明显增高(P<0.01);CD4+CD25+T细胞阳性率治疗前后与正常对照组间差异均无统计学意义;治疗后EDSS评分[(3.64±1.79)分]较治疗前[(4.26±1.68)分]明显下降(P<0.01)。结论GC可上调MS患者淋巴细胞CD80的表达,抑制细胞免疫,促进MS病情缓解。     

负性协同刺激分子PD-1在重症肌无力患者外周血中的表达

目的 观察重症肌无力(MG)患者外周血中负性协同刺激分子programmed death-1( PD-1)的表达情况,并探讨其与MG发病的关系。方法 采用免疫荧光标记、流式细胞仪检测45例MG患者和33名健康对照者外周血单个核细胞中PD-1及其配体PD-L1的表达,用ELISA法检测各组血浆中可溶性PD-1的水平。结果 (1)MG患者表达PD-1的CD4+T淋巴细胞比例增加,CD14+PD-L1+的单核细胞比例增加,但在不同性别及眼肌型与全身型间差异无统计学意义;在胸腺异常MG患者中CD4+PD-1+T细胞增加,CD14+ PD-L1+的单核细胞比例减少;早发型MG患者（年龄＜40岁）CD4+PD-1+T淋巴细胞比例明显低于晚发型（年龄≥40岁）。(2)MG患者血浆中sPD-1浓度为(6.92 +0.72) ng/ml,明显高于健康对照组的(3.28±0.42) ng/ml,但在性别、MG眼肌型与全身型不同类型间和有无胸腺异常各组间差异无统计学意义,且sPD-1与发病年龄呈负相关(r=-0.526,P=0.000)。结论 PD-1及PD-L1途径参与了MG的发病,异常升高的sPD-1可能干扰了正常的细胞膜上PD-1与PD-L1的结合,从而促使疾病进展。     

Soluble CD4 and CD8 in the peripheral blood of patients with multiple sclerosis and HTLV-1-associated myelopathy

We evaluated the presence of soluble (s) CD4 and sCD8, released from activated T cells, in the sera of patients with multiple sclerosis (MS) and human T lymphotropic virus type 1 (HTLV-1)-associated myelopathy (HAM) using an enzyme-linked immunosorbent assay (ELISA). In addition, peripheral blood T cell subsets in patients with MS and HAM were analyzed by single and two color flow cytometry. The serum level of sCD8 was significantly elevated in MS patients as compared with controls (p less than 0.001). Sera from patients with an exacerbation of acute relapsing MS showed a higher sCD8 level than the patients in remission or controls (p less than 0.01 and p less than 0.001, respectively). The serum levels of both sCD4 and sCD8 were also significantly elevated in patients with HAM (p less than 0.001 and p less than 0.001, respectively). In addition, a significantly increased serum level of soluble interleukin-2 receptor (sIL-2R) was found in patients with HAM as compared with that of controls (p less than 0.001). These observations suggest that CD8 cells may be activated in the peripheral blood of patients with MS and sCD8 may be related to clinical activity, but that both CD4 and CD8 cells may be activated in the peripheral blood of patients with HAM.     

The frequency of CD5+ B lymphocytes in the peripheral blood of patients with myasthenia gravis.

A subset of human B lymphocytes expresses Leu-1 (CD5), a pan-T cell marker, which is the equivalent of the murine Lyt-1 molecule. CD5+ B cells produce autoantibodies in vitro; therefore, they may play a role in the pathogenesis of autoimmune disorders. In myasthenia gravis (MG), autoantibodies are directed against the nicotinic acetylcholine receptor (AChR) at the neuromuscular junction. We examined the peripheral blood leukocytes of MG patients (n = 21) and controls (n = 15) for the presence of Leu-1+ B lymphocytes. A fraction of B-1 (CD20)+ cells expressed Leu-1 at a low density. There was a statistically significant difference in the frequency of Leu-1+ B cells between patients and controls. We observed 2 frequency ranges of Leu-1+ B cells (0 to 30% and above 30%), which were not related to the total percentage of B-1+ cells in the blood. Fifty-seven percent of MG patients had a high frequency of Leu-1+ B cells compared with 13% of controls.     

Increased levels of activated T-cells and reduced levels of CD4/CD25+ cells in peripheral blood of Guillain-Barré syndrome patients compared to controls

Guillain-Barré syndrome (GBS) is a severe, self-limiting, autoimmune motor neuropathy. This study was performed to investigate the numbers of activated T-cells and regulatory T-cells, and CD95 and bcl-2 expression in GBS patients compared to controls. The percentage of cells expressing CD69 (activated T-cells) was increased in the blood of both patients with GBS and those with other neuropathies compared to healthy controls. GBS patients displayed significant decreases in the percentage of T-lymphocytes (CD3) and CD4/CD25+ cells (T regulatory cells) compared to patients with other neuropathies and a reduction in the percentage of cytotoxic/suppressor T-lymphocytes (CD8) compared to healthy controls. CD95 expression was reduced in GBS compared to patients with other neuropathies and expression of Bcl-2 was increased in GBS compared to healthy controls. We therefore suggest that in GBS there are increased activated T-cells and disturbances in regulatory T-cells and T-cell apoptosis.