系统性红斑狼疮(SLE)患者几项免疫指标的检测及其意义的探讨

本文报道采用LTT,EtRFCT, EaRFCT和PHA皮试对SLE患者进行细胞免疫功能测定.显示有不等程度的细胞功能低下和T淋巴细胞数的减少.体液免疫功能测定显示48多病例有IgG增高,血清ANA测定阳性串为81.1%,娥识阳性率达99.3%.滴度1≥80,病情活动者较多,斑点核型最常见.周边型、斑点线型和匀质型活动性较高.狼疮性肾病出现蛋白尿者尿ANA测定41.7%阳性.在累及中枢神经系统病例70%脑脊液ANA呈阳性.血清dsDNA间接血凝法测定29.89%阳性.¹²⁵I DNA同位索法测定结果基本上与之平行,这组病例病期较短,肾累及较多,采用PEG沉淀法测定CIC有43%增高,经解离分析CIC的主要内容为核抗原和抗核抗体复合物.CH₅₀和C₃测定有不等程度降低,最后作者对SLE的发病机理进行了讨论.     

SLE患者血清补体第二途径激活的探讨

本文研究SLE发病过程中血清补体替代途径的活化.对36例SLE患者同时测定血清补体ACH₅₀,B因子、CH₅₀,C₃和C₄,其结果表明除经典途径活化外,替代途径亦被激活.其B因子不仅与SLE发病有关,而且与疾病的活动性相关.B因子的变化与C₃,C₄变化相一致,尤其在活动性SLE.     

C3,CH50低下的重症血管性水肿一例报告

本文介绍1例C₃和CH₅₀低下的重症血管性水肿患者,本例以Stanazolol治疗获良效,现报道如下.     

变应性血管炎与免疫复合物的关系

本文采用PPUPA检测了40名HC,50例AAV和23例RAV的CIC浓度,方差分析Q检验发现AAV的CIC浓度高于HC和RAV,具有非常显著意义(P值均小于0.01),HC与RAV之间CIC浓度差别无显著意义(P>0.05).采用PEG沉淀-NS解离一单向免疫扩散试验分析了40名HC,49例AAV和23例RAV的CIC中的某些成份.采用DIF检测了43例AAV早期皮损的血管免疫反应物,其中23例阳性.用配对计数资料X²检验发现,同一AAv患者的CIC中IgA,C₃与DIF结果中IgA,C₃的差别无显著意义(两者P值均大于0.05),CIC与DIF结果中的IgM差别具有非常显著意义(P<0.01),但没有一例CIC中IgM阴性而DIF结果中IgM阳性者.因此认为,CIG与DIF结果中的某些成份基本一致,血管免疫反应物可能来自CIC.本文的研究结果支持CIC在AV的发病机理中起主要作用,并指出,以PPUP人检测的CIC浓度可作为评价AV疗效及估计AV预后的指标.     

85例白斑风患者免疫功能测定

白癜风的免疫功能测定,国内尚无报告.近3年来我们对85例白瘫风患者分别作了E玫瑰花形成试验(ERFT),淋巴细胞转化率(LTT),总补体(CH₅₀),补体第3成分(C₃),循环免疫复合物(CiC),以及IgG,IgA,IgM的检查测定,现报告如下.     

抗不同细胞核成分抗体与SLE病情活动不相关

目的 探讨系统性红斑狼疮(SLE)患者ANA、抗ds-DNA抗体及其他抗细胞核成分抗体水平与SLE病情的相关性。方法 选取2000-2002年我院皮肤与风湿科、肾内科住院及门诊就诊的SLE患者225例进行回顾性研究。用SLE疾病活动性指数(SLEDAI)进行病情活动性评分,按SLEDAI评分将患者分为轻度活动组(≤4分)、中度活动组(5~9分)及重度活动组(≥10分)3组。并对其中52例患者进行追踪观察。结果 ①225例患者抗dsDNA抗体水平和ANA滴度与SLEDAI无相关性(r₁=0.054、P₁=0.662,r₂=0.089、P₂=0.183)。②抗ds-DNA抗体水平在轻度活动组与中度活动组之间差异无显著性(P>0.05),重度活动组明显高于轻度活动组与中度活动组(P<0.01)。ANA滴度在3组之间差异均无显著性。抗Sm抗体、抗RNP抗体、抗SSA、SSB抗体的阳性率在3组之间差异均无显著性(P>0.05)。③根据抗ds-DNA抗体结合率将患者分为<20%(第1组)、≥20%(第2组)两组,两组SLE脑病、肺部病变、浆膜炎、血管炎、关节炎、血象异常的发生率差异无显著性(P>0.05),第2组肾脏损害的发生率高于第1组(P<0.05),但这些有肾脏损害的患者蛋白尿、肌酐水平与抗ds-DNA均无相关性(P>0.05)。④追踪观察52例中30例高度活动组患者抗ds-DNA抗体水平在治疗前高于治疗后(P<0.05),而22例轻、中度活动组抗ds-DNA水平在治疗前后差异无显著性(P>0.05).结论在重度活动组,抗ds-DNA抗体水平与SLE疾病活动有一定相关性;在稳定期,与疾病无相关性.ANA等其他自身抗体与SLE疾病活动无相关性.虽然抗ds-DNA抗体结合率≥20%的患者易伴有肾损害,但与严重程度无相关性.     

DNA甲基转移酶与CD11a基因在SLE患者中的表达

目的 探讨DNA甲基转移酶(DNMT)的表达异常在SLE发病中的作用.方法 以半定量RT-PCR方法检测了SLE缓解期、活动期及正常人外周血单核细胞(PBMC)中DNMT及CD11a基因表达水平,并进行相关性分析.结果 SLE缓解期患者PBMC中DNMT1的表达水平显著低于正常人对照组(t=5.90,P<0.0001);活动期的表达水平也显著低于对照组(t=2.26,P=0.0001);缓解期与活动期比较差异无统计学意义(t=1.75,P=0.089).SLE缓解期、活动期及对照组PBMC中DNMT3A的表达水平差异无统计学意义,DNMT3B的表达水平极低.SLE缓解期PBMC中CD11a表达水平明显高于对照组(t=5.35,P<0.0001);活动期的表达水平显著高于缓解期(t=2.99,P=0.006)和正常人对照组(t=6.57,P<0.0001).DNMT1的降低与SLE疾病活动指数(SLEDAI)间无显著相关性(r=-0.34,P>0.05),CD11a的升高与SLEDAI间呈显著正相关(r=0.48,P<0.05),DNMT1与CD11a间无显著相关性(r=-0.18,P>0.05).结论 DNMT1表达水平降低在SLE的发病中可能起作用.但不是决定DNA甲基化状态的惟一因素.     

银屑病患者自身抗体、循环免疫复合物和补体测定

本文报道91例寻常型银屑病患者自身抗体、循环免疫复合物和补体测定结果,证实抗核抗体、甲状腺球蛋白抗体均阴性.RF阳性率为9.09%.循环免疫复合物阳性率为16.66%, CH₅₀正常,C₃含量减少.对自身抗体和免疫复合物在发病机理中的作用作了初步探讨,认为本病患者体内存在自身免疫反应,深入研究银屑病的免疫发病机理,无论在理论上还是临床上都具有十分重要的意义.     

光暴露及光防护措施与系统性红斑狼疮临床病情相关性研究

目的 探讨系统性红斑狼疮患者的日光暴露时间及光防护措施与其病情的相关性.方法 询问107例系统性红斑狼疮患者日光暴露及光防护措施的态度及行为,并对患者的临床表现、实验室检查指标及治疗予以评估.结果 48例(44.86%)患者每日光暴露<1h,59例(55.14%)患者每日光暴露≥1h.24例(22.43%)患者春、夏两季外出时采取光防护措施.每日光暴露<1h组患者光敏感性、关节痛、脱发、疾病活动、抗dsDNA抗体、C3<800mg/L、C4<180mg/L及CH50<90kU/L的发生率明显低于每日光暴露≥1h组的患者(P<0.05).肾脏受累的发生率两组差异无统计学意义,但前者肾受累的严重程度(尿蛋白>+++)明显低于后者(P<0.01).每日光暴露<1h组治疗使用硫酸羟氯喹片、中高剂量醋酸泼尼松片及联合环磷酰胺冲击治疗的频率均低于每日光暴露≥1h组.治疗后面部蝶形红斑、发热、关节痛及抗核抗体的改善,两组差异无统计学意义,但尿蛋白转阴天数前者明显短于后者(P<0.05).结论 系统性红斑狼疮患者应减少过度日光暴露,加强光防护措施.     

系统性红斑狼疮患者转录因子T-bet和GATA3基因的表达

目的 观察转录因子T-bet和GATA3与系统性红斑狼疮(SLE)病情的关系,探讨T细胞在SLE中的发病机制.方法 利用半定量PCR及实时荧光定量PCR技术检测活动期SLE患者、稳定期SLE患者、正常人外周血单一核细胞(PBMC)中T-bet和GATA3mRNA表达状况.结果 GATA3实时荧光定量PCR△Ct值:活动期(8.92±1.29)明显低于稳定期(12.20±1.18)和正常人(11.80±0.80),所以活动期患者GATA3mRNA表达明显高于稳定期患者和正常人,差异具有非常显著性(P<0.01);半定量PCR显示活动期(0.15±0.15)也明显高于稳定期(0.04±0.05)和正常人(0.03±0.03),差异有显著性(P<0.05);两种方法均显示稳定期患者与正常人GATA3表达差异无显著性(P>0.05).T-bet实时荧光定量PCR△Ct值:活动期为10.52±0.82,稳定期为9.93±1.13,正常人为10.23±1.32;半定量PCR:活动期为0.30±0.23,稳定期为0.28±0.14,正常人为0.22±0.11,两种方法均显示活动期患者、稳定期患者、正常人T-bet表达差异无显著性(P>0.05).结论 调控Th2细胞的转录因子GATA3的升高可能与SLE活动有关,而调控Th1细胞的转录因子T-bet可能与SLE活动无关.     

Circulating immune complexes in recurrent oral ulcers

Serum immunoglobulins (IgG, M, A), serum complements (C3, C4) and circulating immune complexes (CIC) were measured in forty-five patients with recurrent oral ulcers (ROU) and in forty-one healthy controls. The serum levels of immunoglobulins in patients with ROU were significantly higher than normal values. Similar to the pattern during infections, the levels of IgM and IgA gradually decreased as the disease entered the late stage and then returned to normal; the IgG level remained significantly high in the convalescent stage. Although the serum complements were not depressed throughout the course of the disease, a significant amount of CIC was detected in various stages and types of ROU. The three stages of ROU showed an increase in the abnormal percentage of CIC in this order: active early stage (3/14; 21.4%), active late stage (15/39; 38.5%) and convalescent stage (6/15; 40%). Although all three types of ROU demonstrated the variable positivity of CIC [minor, 16/31 (51.6%); major, 3/8 (37.5%); and herpetiform, 3/6 (50%)], their differences were not significant stastistically. This study demonstrated an aberration of humoral immunity of a rather non-specific nature in ROU, probably caused by an infective process. This may suggest that CIC plays only a secondary role in the pathogenesis of ROU.     

SLE患者的红细胞免疫粘附功能变化初探

本文应用郭氏法对38例SLE患者进行红细胞免疫粘附功能变化的研究,其中26例活动期患者的红细胞Cab受体花环率明显低于献血员正常值(t=4.71, P<0.001),红细胞免疫复合物花环率明显高于献血员正常值(t=12.21,P<0.001);12例缓解病人与献血员红细胞Cab受体花环率无明显差别(t=0.28, P>0.05),而与其红细胞免疫复合物花环率尚有明显差别(t=3.34, P<0.01).对14例SLE患者用强的松治疗前后测定红细胞免疫粘附功能变化,并对其临床意义进行了初步探讨.     

Natural Cellular Cytotoxicity in Behçet's Disease

This study evaluated the cytotoxic activity of natural killer cells in the active and inactive stages of Behçet's disease (BD) and attempted to develop a new explanation for its immuno-pathogenesis. Blood samples were taken from 16 BD patients and compared with 11 healthy individuals. The lymphocyte fraction was separated and diluated in RPMI-1640. Candida as a target cell (T) was mixed with lymphocytes (E) (effector cells) in ratios of T:E 1/5 and T:E 1/25. After the numbers of colonies were counted with controls, the anticandidal index (natural cytotoxicity) was calculated. Natural cytotoxicity relatively decreased in the active stage and increased in the inactive stage of BD. Although the difference between the mean value of natural cytotoxicity in the active stage and in the inactive stage was significant, the difference between the averages of active stage and the control group was insignificant. However, the difference between inactive stage and the control group was remarkable. The increase of the natural cytotoxic activity in the inactive period of the disease may play a role together with other immune mechanisms in the aetiopathogenesis of BD.     

Homocysteine: An activity marker in Behçet's disease?

BACKGROUND: Beh?et's disease (BD) is a chronic multisystem inflammatory disorder commonly complicated by vascular thrombosis. OBJECTIVE: In this study, we investigated whether hyperhomocysteinaemia, being a well known risk factor for atherothrombogenesis, is also a contributive risk factor for the pathogenesis and the activation of Beh?et's disease. METHODS: Sixty-four patients fulfilling the criteria of the International Study Group for Beh?et's disease (48 males, 16 females, 33+/-8 years) were enrolled. They were separated into two groups with respect to activation features of Beh?et's disease. Additionally, we collected the blood samples from 13 patients with BD in both active stage and in inactive stage. Twenty-six healthy individuals were included as a negative control group. Serum total homocysteine (Hcy) levels were determined by chemiluminescence immunoassay. RESULTS: Mean serum homocysteine concentrations in total BD patients were significantly higher than in the healthy controls (11.7+/-4.6 versus 8.7+/-2.8micromol/L, p<0.01). Mean serum homocysteine concentrations in the active patients were significantly higher than in the inactive patients and the healthy controls (13.3+/-3.6; 10.8+/-5.0; 8.7+/-2.8micromol/L, respectively) (p<0.05 and p<0.001, respectively). There was no significant difference between the patients with inactive disease and the healthy controls. When the active and the inactive stage of 13 patients with BD were compared, we found that mean serum total homocysteine levels were higher in the active stage than in the inactive stage (p<0.05). CONCLUSION: Hyperhomocysteinaemia may be responsible for the endothelial damage in BD and assumed to be a risk factor and a marker for activation of BD.     

白塞氏病患者外周血中T淋巴细胞亚群的研究

本文用单克隆抗体研究了白塞氏病患者外周血中T细胞亚群的变化.结果表明:与正常人相比,白塞氏病患者外周血中OKT3阳性细胞和Ia阳性细胞比例无明显变化,Leu3a阳性细胞比例减少,Leu2a阳性细胞比例增加,Leu3a/Leu2a比值明显下降.另外还比较了活动期与静止期、完全型与不全型病人之间T细胞亚群的变化,但未见明显差异.     

青蒿琥酯对系统性红斑狼疮样小鼠模型的影响

将亲代B/c鼠淋巴细胞经静脉途径输入到非照射性(C₅₇BL/6×BALB/c)F₁鼠体内,结果诱导出了抗dsDNA抗体和抗组蛋白抗体的持续升高,尿蛋白异常,并发生了免疫复合物介导的肾小球肾炎等系统性红斑狼疮样病变.输入淋巴细胞28天后,每天腹腔注射青蒿琥酯于F₁鼠体内,显示了青蒿琥酯可明显抑制疾病的发展.     

血清双链去氧核糖核酸抗体对一系统型红斑性狼疮意义的进一步探讨

系统垫红斑性狼疮(SLE)的发病率有增高趋势,有关的研究也在广泛开展.临床表现多样和复杂,根据抗核抗体的种类结合临床表现,作者将百分成各种亚型(1.2).