C反应蛋白在鉴别系统性红斑狼疮活动与合并感染中的意义

目的通过分析系统性红斑狼疮(system ic lupus erythem atosus,SLE)病情活动和合并感染患者的临床和血清学特点,发现对疾病活动和感染有鉴别意义的指标。方法对2003—2004年在我科住院的110例SLE患者进行回顾性分析,比较病情活动未合并感染者87例(未感染组)和合并感染者23例(感染组)的发热、皮疹、口腔溃疡、脏器损害等临床表现,同时分析患者的C反应蛋白(CRP),血沉(ESR),血清蛋白电泳(白蛋白、α1球蛋白、α2球蛋白、β球蛋白、γ球蛋白),补体(C3、C4),免疫球蛋白(IgA、IgM、IgG)及免疫复合物(CIC)的变化。结果感染组CRP、ESR及α1球蛋白高于未感染组(P<0.01)。通过比较CRP、ESR及α1球蛋白与其他临床指标的相关性,发现CR P受感染之外的影响较少,在未感染组CRP浓度的均数在正常水平,合并感染后明显升高。感染组患者的发热、口腔溃疡、雷诺现象、心脏损害及糖皮质激素用量均高于未感染组(P<0.05)。结论譹SLE合并感染时大部分患者的CR P明显升高。譺在狼疮活动时CR P大多正常或略高,但少数患者,尤其合并浆膜炎者的CR P水平可较高。CRP对于鉴别狼疮活动与合并感染有重要的临床应用价值。     

Arterial thrombotic manifestations in young women associated with the lupus anticoagulant

Summary To demonstrate the wide variety of clinical syndromes associated with the lupus anticoagulant (LAC), we report the case histories of three young females with arterial thrombosis in whom LAC was demonstrated. Two patients had a diagnosis of systemic lupus erythematosus and mixed connective tissue disease respectively; the other patient had no signs of underlying auto-immune disease. Arterial thrombotic events in young females should arouse suspicion of the presence of LAC although its pathophysiological significance is not established.     

Multiple autoantibody production in a patient with splenic lymphoma

Summary We report on a patient with splenic lymphoma of B-cell origin who developed autoimmune hemolytic anemia (AIHA). IgM M-protein, IgM anticardiolipin antibody (ACA), and lupus anticoagulant (LA) were detected in the serum, and direct Coombs' test showed autoantibodies of the IgG₁ and IgG₂ subclasses on red blood cells (RBC). In in vitro culture, tumor cells isolated from the spleen produced only IgM ACA, which was enhanced by IL-6 but not by IL-4 or IL-5. The levels of ACA and LA decreased after splenectomy and chemotherapy; the strength of the direct Coombs' test, however, did not change. These findings indicated that in this patient the lymphoma cells produced IgM. ACA, but not autoantibodies of the IgG₁ and IgG₂ subclasses against RBC. It was also suggested that IL-6 might at least partially stimulate the production of ACA.     

The effect of intravenous cyclophosphamide pulse on peripheral blood lymphocytes in lupus erythematosus patients

In the present study we investigated the long-term effect of intravenous pulse cyclophosphamide (CY) on lymphocyte surface antigens in systemic lupus erythematosus (SLE) patients. Blood samples derived from 17 lupus erythematosus patients were analysed using two- and three-colour flow cytometry. During the CY therapy, the total number of T lymphocytes (CD3+) was reduced by 31.4%, B lymphocytes (CD19+) by 67.4% and NK cells (CD16+) by 27.4%. Six months after the end of the CY regimen, these values recovered to entry levels. At the onset of the study we observed increased percentages of CD3+ CD25+, CD3+ CD4– CD8–, CD4+ CD29+, CD19+ and CD19+ CD5+ cells. The CY treatment regimen decreased the CD3+ CD25+, CD3+ CD4– CD8–, CD19+ and CD19+ CD5+ cells, but increased the CD3+ CD8+ subpopulation. Taken together, a deficiency of CD8+ T cells associated with CD4+ CD29+ predominance may imply an immune regulatory imbalance leading to abnormal CD4+ cell activation and in consequence to autoimmunity. Depletion of CD19+ cells combined with an enlargement of CD8 cells as a result of CY therapy may reduce the enhanced immune response in SLE patients. Received: 13 December 1996 / Accepted: 10 March 1997     

重症狼疮肾炎患者血清TNF-α与sTNF-R水平及甲泼尼龙与环磷酰胺双冲击治疗对其的影响

目的探讨重症狼疮肾炎(SLN)患者血清肿瘤坏死因子!(TNF-!)、可溶性肿瘤坏死因子受体(sTNF-R)的水平、sTNF-R/TNF-!比值及甲泼尼龙(MP)与环磷酰胺(CTX)双冲击治疗对其的影响。方法采用双抗体夹心酶联免疫吸附试验(ELISA)检测35名健康人(正常对照组)和38例SLN患者经MP与CTX双冲击治疗前后血清TNF-!、sTNF-RⅠ、sTNF-RⅡ的水平;抗双链DNA抗体采用ELISA法测定;抗核抗体采用间接免疫荧光法检测;补体C3、C4含量采用速率散射比浊法测定。结果SLN患者血清中TNF-!、sTNF-RⅠ、sTNF-RⅡ水平及TNF-!/sTNF-RⅠ、TNF-!/sTNF-RⅡ比值均显著高于正常对照组(P<0.01),且sTNF-RⅡ增高幅度明显高于sTNF-RⅠ(P<0.01),TNF-!、sTNF-RⅠ、sTNF-RⅡ水平与系统性红斑狼疮疾病活动指数(SLEDAI)评分、抗核抗体、抗双链DNA抗体、血沉、24h尿蛋白定量、血尿素氮(BUN)、血肌酐(Scr)呈显著正相关(P<0.05或P<0.01),与补体C3、C4、内生肌酐清除率(Ccr)呈显著负相关(P<0.05或P<0.01);sTNF-RⅠ与sTNF-RⅡ之间呈显著正相关(P<0.01)。MP与CTX双冲击治疗能显著降低SLN患者血清TNF-!、sTNF-RⅠ、sTNF-RⅡ水平及sTNF-RⅠ/TNF-!、sTNF-RⅡ/TNF-!比值(P<0.01)。结论TNF-!、sTNF-R参与了SLN的发病过程,血清TNF-!、sTNF-RⅠ、sTNF-RⅡ在一定程度上可反映SLN患者肾脏损害程度、病情轻重。动态观察血清TNF-!、sTNF-RⅠ、sTNF-RⅡ水平及sTNF-R/TNF-!比值,有助于判断SLN的狼疮活动、治疗效果及预后。MP与CTX双冲击疗法可能通过抑制SLN患者单核/巨噬细胞、T细胞产生TNF-!而发挥治疗作用。     

马疫锥虫动基体DNA诱导抗dsDNA抗体产生条件与致病性的研究

目的研究不同免疫途径对马疫锥虫动基体DNA(kDNA)诱导正常小鼠产生抗双链DNA(dsDNA)抗体及其致病性的影响。方法将马疫锥虫kDNA与不完全弗氏佐剂乳化混合,通过皮下、腹腔、肌肉及静脉等途径注射入正常BALB/C小鼠。8周后,检测小鼠血清抗dsDNA抗体亚型及滴度、血尿素氮(BUN)、血肌酐(Scr)、补体C3、24h尿蛋白浓度、肾小球免疫复合物沉积强度、肾组织病变活动指数等,并分析肾组织病理学特征。结果上述各组小鼠产生IgG型抗dsDNA抗体量及肾损害程度依次为:皮下组>腹腔组>肌肉组>静脉组(P<0.05);IgG型抗dsDNA抗体与肾组织病变活动指数呈正相关。结论不同免疫途径对马疫锥虫kDNA诱导抗dsDNA抗体产生有明显不同影响,其导致的狼疮样肾脏损害与该抗体亚型有关。     

CD40反义RNA对系统性红斑狼疮患者B淋巴细胞功能的影响

目的　探讨瞬间表达的CD4 0反义RNA对EB病毒转染的系统性红斑狼疮 (SLE)患者B淋巴细胞CD4 0分子表达、细胞增生以及免疫球蛋白 (Ig)分泌功能的影响。 方法　构建人CD4 0反义RNA的真核表达载体CD4 0 /pcDNA3,并将其转染入EB病毒转染的SLE患者B淋巴细胞中。应用流式细胞仪 (FACS)检测观察B淋巴细胞膜上CD4 0分子表达的变化 ;应用四甲基偶氮唑盐微量酶反应比色法 (MTT)观察反义CD4RNA对B淋巴细胞增生能力的影响 ;应用酶联免疫吸附试验(ELISA)测定转染后的B淋巴细胞的Ig分泌功能。结果　与转染pcDNA3空载体组相比 ,转染CD4 0 / pcDNA3组的CD4 0分子的表达明显降低 (P <0 0 1) ;细胞的增生能力明显降低 (P <0 0 5 ) ;细胞的Ig分泌功能明显受抑制 (P <0 0 1)。结论　CD4 0反义RNA对SLE患者的B淋巴细胞有明显的免疫调控作用。