肿瘤坏死因子超家族与系统性红斑狼疮研究进展

系统性红斑狼疮(SLE)是一种自身免疫病,疾病发生与自身反应性T、B细胞出现,自身抗体形成有关,多种细胞因子参与发病。肿瘤坏死因子(TNF)超家族(TNFSF)成员众多,空间结构相似,有不同程度同源性。配体为Ⅱ型跨膜糖蛋白,能以膜结合或可溶性形式发挥作用；受体为Ⅰ型或Ⅲ型膜蛋白。受体与配体结合,启动下游信号转导,诱导细胞生长、分化和凋亡,在组织自稳、炎症的免疫调节中发挥重要作用。TNF、CD40/CD40L、Fas/FasL与SLE的关系很早就受到关注,本文把近年来与SLE相关的TNFSF中的几个细胞因子作一综述。     

不同性别患者晚发强直性脊柱炎临床特征比较

目的:比较不同性别患者晚发强直性脊柱炎的临床特征.方法:收集2010～2019年在弋矶山医院风湿科住院的晚发强直性脊柱炎患者资料,分成男性组和女性组,比较两组临床资料并做统计学分析.结果:男性组起病时炎性腰背痛更常见,差异有统计学意义(P<0.05);男性骶髂关节炎和骨桥虽然比女性严重,但差异无统计学意义(P>0.05...     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗12例强直性脊柱炎近期疗效

目的:评价重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(recombinant human tumornecros is factor-α receptorⅡ:IgG Fc fusion protein,rh TNFR:Fc)治疗12例强直性脊柱炎(AS)患者的临床疗效、安全性,以及随访半年的结果。方法:12例AS患者,男10例,女2例,rhTNFR:Fc每周2次皮下注射,每次25mg,连用3个月后停用观察。主要评价指标:晨僵持续时间,腰背痛和外周关节痛变化,治疗后第1、3、9个月红细胞沉降率(ESR)、C反应蛋白(CRP)、枕-墙距、指-地距的变化。结果:治疗1月后外周关节痛和腰背痛等症状显著改善,ESR由(54.41±28.21)mm/h降至(19.0±16.0)mm/h(P=0.00017)、CRP由(70.40±100.57)mg/L降至(5.29±5.62)mg/L(P=0.04),治疗3月后ESR和CRP完全降至正常。指-地距和枕-墙距在1、3和9月较基线亦有明显改善。治疗期间除1例合并上呼吸道感染外,无其他不良反应出现。停止治疗后随访6个月,复发3例,其中2例于停药后1个月复发,另1例停药后3个月复发。结论:rhTNFR:Fc25mg皮下注射、每周2次联用3个月,治疗强直性脊柱炎起效快,安全性好,本组病例3/12例于停药后复发,远期疗效有待继续观察。     

SLE患者外周血T、B淋巴细胞TLR9蛋白表达及与临床指标的关系

Objective To study the expressions of Toll-like receptor 9 protein (TLR9) in peripheral B and T lymphocytes in newly diagnosed, untreated patients with systemic lupus erythematosus (SLE) and their relationship with clinical parameters. Methods Blood samples were obtained from 35 newly diag-nosed, untreated patients with SLE and 16 healthy human controls. B, T lymphocytes and TLR9 protein were labeled with fluorescent antibodies, and the expressions of TLR9 protein were detected by flow cytometry in peripheral B and T lymphocytes. The relationship between TLR9 expression and clinical parameters was assessed. Results The proportions of B and T lymphocytes expressing TLR9 in newly diagnosed, untreated patients were (53.94±17.95)% and (49.33 ± 23.30)%, respectively, compared to (29.40 ± 10.54)% and (29.18 ± 14.78)%, respectively, in healthy controls (t = 6.11,3.73, respectively, both P < 0.01). Additionally,the proportion of B lymphocytes expressing TLR9 correlated negatively with SLE disease activity index (SLEDAI)(r = -0.39, P < 0.05), but positively with the level of serum IgA antibody (r = 0.74, P < 0.01).Condnsions The expression of TLR9 is elevated in peripheral T and B lymphocytes from patients with newly diagnosed, untreated SLE, and the proportion of TLR9-expressing B lymphocytes negatively correlates with SLEDAI, but positively correlates with the serum level of IgA antibody.     

SLE患者外周血T、B淋巴细胞TLR9蛋白表达及与临床指标的关系

Objective To study the expressions of Toll-like receptor 9 protein (TLR9) in peripheral B and T lymphocytes in newly diagnosed, untreated patients with systemic lupus erythematosus (SLE) and their relationship with clinical parameters. Methods Blood samples were obtained from 35 newly diag-nosed, untreated patients with SLE and 16 healthy human controls. B, T lymphocytes and TLR9 protein were labeled with fluorescent antibodies, and the expressions of TLR9 protein were detected by flow cytometry in peripheral B and T lymphocytes. The relationship between TLR9 expression and clinical parameters was assessed. Results The proportions of B and T lymphocytes expressing TLR9 in newly diagnosed, untreated patients were (53.94±17.95)% and (49.33 ± 23.30)%, respectively, compared to (29.40 ± 10.54)% and (29.18 ± 14.78)%, respectively, in healthy controls (t = 6.11,3.73, respectively, both P < 0.01). Additionally,the proportion of B lymphocytes expressing TLR9 correlated negatively with SLE disease activity index (SLEDAI)(r = -0.39, P < 0.05), but positively with the level of serum IgA antibody (r = 0.74, P < 0.01).Condnsions The expression of TLR9 is elevated in peripheral T and B lymphocytes from patients with newly diagnosed, untreated SLE, and the proportion of TLR9-expressing B lymphocytes negatively correlates with SLEDAI, but positively correlates with the serum level of IgA antibody.     

混合性结缔组织病合并慢性脱髓鞘病变一例报告

混合性结缔组织病（MCTD）及慢性格林巴利综合征均属自身免疫性疾病，两者发病机制尚不明确，同时合并则甚为罕见，Luostarinen曾报道1例，本文报告1例如下。     

92例多发性肌炎／皮肌炎患者短期生存预后相关因素分析

目的：探索影响多发性肌炎／皮肌炎（PM／DM）患者短期生存及预后危险因素。方法：收集2006年7月至2013年7月本院住院治疗101例PM／DM患者临床资料和相关实验室检查,9例失访,随访92例患者为研究对象,分死亡组和非死亡组,分析影响短期生存和预后危险因素。结果：92例患者中男29例,女63例,其中PM41例,DM51例,死亡15例,其中PM4例,DM11例。死亡组患者年龄（59．1±10．6）岁高于非死亡组（44．3±12．9）岁,中位数病程[9（3～123）]月明显短于非死亡组[-46（4～174）]月,血清白蛋白（ALB）水平[（31．9±4．3）g／L]低于非死亡组[（37．4±6．1）g／L],死亡组患者红细胞沉降率（ESR）[（46．1±32．6）mm／h]高于非死亡组（30．6±24．9）mm／h],C反应蛋白（CRP）水平[（32．5±25．4）mg／L]高于非死亡组[（18．0±11．7）mg／L],差异有统计学意义（P分别为0．045和0．026）。死亡组间质性肺病（ILD）发生率（11／15,73．33％ vs 29／77,37．66％）、心脏损害发生率（9／15,60．00％VS24／77,31．17％）及肺部感染发生率（10／15,66．67％ vs 524／77,31．170）均高于非死亡组,差异均有统计学意义。预测PM／DM患者1、5、10年生存率分别为88．7％、82．3％、59．5O,多因素COX回归显示年龄[χ2=14．128,P〈0．001,RR为1．102,95％CI（1．048～1．160）]、合并ILD[χ2=4．642,P=0．031,RR为0．284,950CI（0．090～0．893）]、低ALB血症[χ2=7．543,P=0．006,RR为0．890,95％CI（0．819～0．967）]、心脏损害[χ2=4．980,P=0．026,RR为0．306,95％CI（0．108～0．866）]及合并肺部感染[χ2=5．451,P=0．020,RR为0．277,950CI为（0．095～0．140）]均是影响其预后危险因素。结论：PM／DM死亡组患者年龄大、病程短,血清ALB水平偏低,ILD、心脏损害及肺部感染发生率高,其中年龄、低ALB血症、合并ILD?     

TRAIL在系统性红斑狼疮发病机制中的作用及其相关性研究

目的探索肿瘤坏死因子相关凋亡诱导配体(TRAIL)在系统性红斑狼疮(SLE)细胞凋亡、自身抗体产生和疾病活动中作用。方法60例SLE患者及20名健康对照,反转录聚合酶链反应(RT-PCR)半定量分析外周血单个核细胞(PBMC)的TRAIL mRNA表达;比色法测定PBMC内Caspase-3活性表达;酶联免疫法(ELISA)测定PBMC内核小体水平、血清中可溶性TRAIL(sTRAIL)和抗核小体抗体(AnuA)浓度。结果狼疮活动组与稳定组及健康对照组相比,TRAILmRNA平均表达水平(0.82±0.07)vs(0.77±0.06)vs(0.75±0.05)、Caspase-3活性(0.53±0.27)vs(0.39±0.23)vs(0.35±0.18)、核小体浓度(U/ml)((3.09)vs(0.53)vs(0.77)及血清sTRAIL水平(μg/L)(0.88±0.74)vs(0.58±0.32)vs(0.48±0.28),差异均有显著性(P<0.05)。SLE患者TRAILmRNA平均表达水平与sTRAIL、Caspase-3活性及Caspase-3活性与核小体水平均呈显著正相关(P<0.05)。SLE患者TRAIL mRNA表达水平与SLE疾病活动指数(SLEDAI)积分数、抗dsDNA抗体、ESR、AnuA浓度呈正相关,与淋巴细胞计数及补体C4呈负相关;sTRAIL浓度与SLEDAI积分数呈正相关,与淋巴细胞计数呈负相关。核小体浓度与SLEDAI积分数、抗dsDNA抗体、AnuA浓度均呈显著正相关,与补体C3、C4水平呈负相关。结论SLE活动患者PBMC的TRAIL表达水平及血清sTRAIL水平增高,凋亡酶Caspase-3的活性增高,可能介导PBMC异常凋亡,使核小体释放增加,自身抗体水平增加,参与疾病活动。     

以骶髂关节炎为突出表现的痛风一例

本文报道了一例以骶髂关节炎为突出表现的痛风患者,最终行骶髂关节双能CT提示右侧髂骨及骶骨尿酸盐沉积得以确诊。以骶髂关节为首发部位的痛风临床较为少见,极易误诊为强直性脊柱炎,需引起临床医师重视,避免误诊误治。     

SLE患者血清及外周血单个核细胞中IL-12、IL-18的检测及临床意义

目的探讨系统性红斑狼疮（SLE）患者IL-12、IL-18的表达及与疾病活动的关系。方法应用ELISA法以及半定量RT-PCR法分别测定SLE活动组、缓解组和对照组血清IL-12、IL-18水平以及外周血单个核细胞中的IL-12 mRNA和IL-18 mRNA的表达。结果SLE活动组IL-18 mRNA、IL-18的表达较SLE缓解组和正常对照组明显升高（P均〈0.05）。血清IL-18水平与IL-12水平呈负相关（r=-0.406,P=0.019）。SLE患者SLE疾病活动指数与IL-12、IL-12 mRNA呈负相关（r=-0.617,P〈0.05;r=-0.512,P〈0.05）,与IL-18、IL-18 mRNA呈正相关性（r=0.817,P〈0.05;r=0.806,P〈0.01）。结论SLE活动组患者中存在IL-18异常高表达和IL-12异常低表达,二者之间呈负相关,在SLE发病和发展中可能起不同作用。