调节性T细胞在系统性红斑狼疮患者中的研究

目的 研究系统性红斑狼疮(SLE)患者外周血调节性T细胞(Treg)的变化及其与病情活动的相关性,探讨Treg细胞在SLE发病机制中的作用.方法 用四色分选流式细胞仪检测103例SLE患者及58名健康对照人群外周血Treg细胞百分数(%).SLE活动性的判断采用SLEDAI评分方法,其中非活动期(SLEDAI≤9分)患者37例,活动期(SLEDAI＞9分)患者66例.分析以上SLE患者外周血Treg细胞百分数的变化及其与病情活动的相关性.结果 ①SLE患者组Treg细胞(%)(1.59±1.21)显著低于健康对照组(2.62±1.76),P＜0.05;②SLE活动组Treg细胞(%)(1.53±1.28)显著低于SLE非活动组(2.14±1.97),P＜0.05,SLE活动组Treg细胞(%)(1.53±1.28)显著低于健康对照组(2.62±1.76),P＜0.05,SLE非活动组Treg细胞(%)(2.14±1.97)显著低于健康对照组(2.62±1.76),P＜0.05.③Treg细胞百分数与SLEDAI评分呈显著负相关.结论 SLE患者外周血Treg细胞百分数存在显著异常,并与疾病活动性密切相关,说明Treg细胞可能在SLE的发生、发展中起重要作用,为SLE的发病机制和治疗提供新的思路.     

调节性T细胞在系统性红斑狼疮患者中的研究

目的研究系统性红斑狼疮（SLE）患者外周血调节性T细胞（Treg）的变化及其与病情活动的相关性,探讨Treg细胞在SLE发病机制中的作用。方法用四色分选流式细胞仪检测103例SLE患者及58名健康对照人群外周血Treg细胞百分数（%）。SLE活动性的判断采用SLEDAI评分方法,其中非活动期（SLEDAI≤9分）患者37例,活动期（SLEDAI〉9分）患者66例。分析以上SLE患者外周血Treg细胞百分数的变化及其与病情活动的相关性。结果①SLE患者组Treg细胞（%）（1.59±1.21）显著低于健康对照组（2.62±1.76）,P〈0.05;②SLE活动组Treg细胞（%）（1.53±1.28）显著低于SLE非活动组（2.14±1.97）,P〈0.05,SLE活动组Treg细胞（%）（1.53±1.28）显著低于健康对照组（2.62±1.76）,P〈0.05,SLE非活动组Treg细胞（%）（2.14±1.97）显著低于健康对照组（2.62±1.76）,P〈0.05。③Treg细胞百分数与SLEDAI评分呈显著负相关。结论 SLE患者外周血Treg细胞百分数存在显著异常,并与疾病活动性密切相关,说明Treg细胞可能在SLE的发生、发展中起重要作用,为SLE的发病机制和治疗提供新的思路。     

Nonmyeloablative hematopoietic stem cell transplantation for systemic lupus erythematosus

Context  Manifestations of systemic lupus erythematosus (SLE) may in most patients be ameliorated with medications that suppress the immune system. Nevertheless, there remains a subset of SLE patients for whom current strategies are insufficient to control disease. Objective  To assess the safety of intense immunosuppression and autologous hematopoietic stem cell support in patients with severe and treatment-refractory SLE. Design, Setting, and Participants  A single-arm trial of 50 patients with SLE refractory to standard immunosuppressive therapies and either organ- or life-threatening visceral involvement. Patients were enrolled from April 1997 through January 2005 in an autologous nonmyeloablative hematopoietic stem cell transplantation (HSCT) study at a single US medical center. Interventions  Peripheral blood stem cells were mobilized with cyclophosphamide (2.0 g/m²) and granulocyte colony-stimulating factor (5 µg/kg per day), enriched ex vivo by CD34⁺ immunoselection, cryopreserved, and reinfused after treatment with cyclophosphamide (200 mg/kg) and equine antithymocyte globulin (90 mg/kg). Main Outcome Measures  The primary end point was survival, both overall and disease-free. Secondary end points included SLE Disease Activity Index (SLEDAI), serology (antinuclear antibody [ANA] and anti–double-stranded (ds) DNA), complement C3 and C4, and changes in renal and pulmonary organ function assessed before treatment and at 6 months, 12 months, and then yearly for 5 years. Results  Fifty patients were enrolled and underwent stem cell mobilization. Two patients died after mobilization, one from disseminated mucormycosis and another from active lupus after postponing the transplantation for 4 months. Forty-eight patients underwent nonmyeloablative HSCT. Treatment-related mortality was 2% (1/50). By intention to treat, treatment-related mortality was 4% (2/50). With a mean follow-up of 29 months (range, 6 months to 7.5 years) for patients undergoing HSCT, overall 5-year survival was 84%, and probability of disease-free survival at 5 years following HSCT was 50%. Secondary analysis demonstrated stabilization of renal function and significant improvement in SLEDAI score, ANA, anti-ds DNA, complement, and carbon monoxide diffusion lung capacity adjusted for hemoglobin. Conclusions  In treatment-refractory SLE, autologous nonmyeloablative HSCT results in amelioration of disease activity, improvement in serologic markers, and either stabilization or reversal of organ dysfunction. These data are nonrandomized and thus preliminary, providing the foundation and justification for a definitive randomized trial. Clinical Trial Registration  ClinicalTrials.gov Identifier: NCT00271934      

男性系统性红斑狼疮20例临床及误诊分析

对１９８６￣１９９４年底收治的２０例男性系统性红斑狼疮（ＳＬＥ）的特点，首次就诊主诉症状及误诊疾病进行进行了分析。患者首次就诊主诉症状多为发热，面部和／或其它部位皮疹，关节痛及浮肿。２０例患者中，首次发病即确诊的有３例，其余的１７例被误诊１个月对３年不等。     

The association of systemic lupus erythematosus and myasthenia gravis.

Two women with the rare association of systemic lupus erythematosus (SLE) and myasthenia gravis (MG) are reported. The first patient developed SLE (arthritis, severe thymectomy for MG. The second patient developed SLE (oral ulcers, arthritis, serositis, leukopenia, high titres of anti-DNA and anti-nuclear antibodies) 4 years prior to the clinical and serological onset of MG. Lymphocyte subsets and in vitro proliferative responses of peripheral blood mononuclear cells to mitogens were normal in both patients. A review of the literature revealed 26 additional patients with definite SLE coexisting with MG. Besides the theoretical interest of this association, the differential diagnosis of fatigue in patients with SLE should always include the possibility of MG.