辅助性T细胞17功能异常在系统性红斑狼疮心脏损害中的意义

目的 探讨辅助性T细胞(Th)17介导的炎症损伤与系统性红斑狼疮(SLE)心脏损害的关系,了解若干常用的心肌标志物作为狼疮心脏受累预测、评价指标的可行性.方法 采用酶联免疫吸附试验( ELISA)法检测47例SLE心脏损害患者、55例SLE无心脏损害患者及38名健康对照血清白细胞介素(IL)-17A水平；应用ADVIA Centaur(R) XP系统与Olympus AU2700全自动生化仪检测心肌标志物水平；应用实时荧光定量聚合酶链反应(real-time qPCR)方法相对定量13例SLE心脏损害患者、14例SLE无心脏损害患者及13名健康对照外周血单个核细胞(PBMCs)中孤核受体(ROR)Υt基因表达水平.计量资料的比较采用Kruskal-Wallis检验、Mann-Whitney U检验或独立样本F检验,相关性分析采用直线回归或Spearman相关分析.结果 ①SLE心脏损害组血清IL-17A水平较SLE无心脏损害组及健康对照组均显著升高27.98(8.44～138.81),11.12(3.64～22.30),5.77(2.22～9.60) pg/ml;P均＜0.05].②SLE心脏损害组脑利钠肽水平较SLE无心脏损害组及健康对照组均显著升高49(13.50～107.50),17(9～26),7.50(4.75～13)pg/ml;P均＜0.01].③SLE心脏损害组年龄、SLE疾病活动度、病程较SLE无心脏损害组均显著升高(P＜0.01或P＜0.05).④SLE心脏损害组RORΥt基因表达水平较SLE无心脏损害组及健康对照组均显著升高2.2(0.79～2.83),0.72(0.39～1.14),0.19(0.15～0.75);P＜0.05].结论 ①Th17细胞可能参与了SLE心脏损害的发生；②高龄、病程长及疾病活动度高的SLE患者心脏损害发生概率增高；③脑利钠肽有望成为SLE心脏损害的预测、评价指标.

Changes of Th17 cells in systemic lupus erythematosus with cardiac involvement

Objective To investigate the role of Thl7 cells in the pathogenesis of SLE patients with cardiac involvement,and to understand the value of cardiac markers in SLE patients with cardiac involvement.Methods Serum IL-17A levels were measured by enzyme-linked immunosorbent assay in 47 SLE patients with cardiac involvement (group Ⅰ ),55 SLE patients without cardiac involvement (group Ⅱ ) and 38 healthy controls (group Ⅲ ).The ADVIA Centaur(R)-XP immunoassay analysis system and Olympus AU2700 automatic biochemical system were used to measure cardiac markers.Then real time-quantitative polymerase chain reaction was used to measure RORγt mRNA in 13 SLE patients with cardiac involvement,14 SLE patients without cardiac involvement and 13 healthy controls.Kruskal-Wallis test,Mann-Whitney U test,F test and Spearman correlation were used for statistical analysis.Results ① Serum levels of IL-17A were markedly increased in group Ⅰ than group Ⅱ and Ⅲ 27.98 (8.44-138.81) vs 11.12 (3.64-22.30) vs 5.77 (2.22-9.60) pg/ml,both P＜0.05].② Serum levels of BNP were significantly higher in group Ⅰ than group Ⅱ and Ⅲ 49(13.50-107.50) vs 17(9-26) vs 7.50(4.75-13) pg/ml,both P＜0.01 ].③ Age,course,SLEDAI were significantly higher in group Ⅰ SLE patients than group Ⅱ (P＜0.01 or P＜0.05).④ The level of RORγt mRNA were significantly elevated in group Ⅰ compared to group Ⅱ and Ⅲ 2.2(0.79-2.83) vs 0.72(0.39-1.14) vs 0.19(0.15-0.75),P＜0.05].Conclusion ① Th17 cells may contribute to the inflammation of heart in SLE.② The older age,longer course and higher disease activity of SLE patients are risk factors for cardiac involvement in SLE.③ Serum BNP may be a useful indicator in SLE patients with heart involvement.