系统性红斑狼疮患者血清中IL-17 的检测及临床意义

目的:通过检测系统性红斑狼疮(SLE)患者外周血中IL-17的水平,探讨其临床意义。方法:用酶联免疫吸附法(enzymelinked immunosorbent assay,ELISA)检测61例SLE患者及30例健康人血清IL-17水平,并收集整理SLE患者的临床资料及实验室数据,分析其与临床的关系。结果:活动期SLE患者血清IL-17水平明显高于正常对照组(P<0.01),与SLE非活动组相比,差异亦有统计学意义(P<0.01)。但SLE非活动组与正常对照组间无统计学意义。结论:IL-17水平在活动期SLE患者血清中表达明显增高,且与SLEDAI评分呈正相关,提示IL-17可能参与了SLE疾病的病理过程,可能与疾病活动的关系密切。     

系统性红斑狼疮患者的护理

系统性红斑狼疮(SLE)是自身免疫介导的以免疫性炎症为突出表现的弥漫性结缔组织病,其突出表现为多系统、多脏器受累。因此,根据不同的临床时期,对患者实施个体化的护理措施,对缓解病情,提高患者的生活质量,减少致残率和死亡率具有积极的临床意义。1临床资料我科自2001年5月至2007年5月共收住院治疗的系统性红斑狼疮患者41例,男15例,女26例,年龄最大60岁,最小13岁,平均34岁。病程最长8年,最短1年。2护理体会2·1一般护理对患者进行健康教育,使其正确认识疾病,明白规律用药的重要意义,学会自我认识疾病活动的征象,积极配合治疗,遵从医嘱,定…     

系统性红斑狼疮患者和正常人血清IgG结构的光谱学研究

园二色谱和萤光光谱的研究表明,ＳＬＥ患者和正常人血清ＩｇＧ分子以及ＩｇＧ－Ｆ（ａｂ＇）２片段在结构上都存在明显的差异．同正常人相比,ＳＬＥ患者血清ＩｇＧ园二色谱中２１３ｎｍ处负峰的椭园值比正常人的高出近一倍,ＩｇＧ分子中的疏水基团（如Ｔｒｐ等）处于正电区,并且趋向于分布在蛋白质分子的表面．ＤＮＡ时ＩｇＧ空间结构影响很小,虽然高浓度的ＤＮＡ有熄灭ＩｇＧ分子萤光的作用,但是低浓度ＤＮＡ对正常人血清ＩｇＧ的萤光几乎没有影响．Ｆｅ２＋引起ＳＬＥ患者和正常人ＩｇＧ的紫外吸收光谱出现明显的差别。     

血β2微球蛋白水平在系统性红斑狼疮中的临床意义

目的：探讨系统性红斑狼疮（systemic lupus erythematosus,SLE）患者血β2-MG水平与疾病活动的相关性及其临床意义。方法：随机抽取2012年2月-2012年7月我科收治的62例SLE患者（SLE组）和同期在我院门诊体检的健康体检者40例（对照组）,检测和比较两组血清β2-MG、自身抗体、补体水平,并对SLE患者进行SLEDAI评分,分析SLE患者血清β2-MG水平与自身抗体、补体水平和SLEDAI评分的相关性。结果：SLE组血β2-MG水平（3．11±0．40μg／mL）显著高于对照组（2．23±0．23μg/mL）,差异有统计学意义（P〈0．05）;其中发生口腔溃疡、浆膜炎及蛋白尿的SLE患者的血β2-MG水平与无此三种表现的患者相比显著升高,差异有统计学意义（P〈0．05）。SLE患者的血β2-MG水平与抗ds—DAN抗体、SLEDAI均呈显著正相关（分别为r=0．289,r=0．361,P〈0．01）,与C3呈负相关（r=-0．271,P〈0．05）。结论：SLE患者血β2-MG水平高于正常,可作为SLE疾病活动指标用于监测疾病活动。     

系统性红斑狼疮患者血清中CD83与自身抗体的表达及其相互关系

目的：检测系统性红斑狼疮（systemic lupus erythematosus,SLE）患者血清中CD83（soluble CD 83,sCD 83）和多种自身抗体的表达水平,并探讨其相互关系。方法：ELISA检测患者可溶性CD 83和AnuA的表达,应用间接免疫荧光的方法检测抗cmDNA抗体,应用乳凝法检测血清中的DNP,采用胶体金标记和快速膜渗滤技术测定血清中的抗dsDNA抗体。结果：对照组患者血清中可溶性CD 83的表达为（0.26±0.10）ng/ml,实验组患者血清中可溶性CD 83的表达为（5.56±0.72）ng/ml。与对照组相比,实验组患者血清中可溶性CD 83的平均浓度明显升高。在抗dsDNA抗体阴性的51例系统性红斑狼疮患者中AnuA的阳性率明显高于抗DNP抗体和抗cmDNA抗体,同样在抗DNP抗体阴性的58例系统性红斑狼疮患者中AnuA的阳性率明显高于dsDNA抗体和抗cmDNA抗体。系统性红斑狼疮患者中可溶性CD83的水平（〈2.68 ng/ml）与各种自身抗体（抗dsDNA抗体、AnuA、抗DNP抗体和抗cmDNA抗体）水平的相关系数分别为（r=0.542,0.613,0.489和0.367）。具有高水平可溶性CD83的系统性红斑狼疮患者（≥2.68 ng/ml）,与各种自身抗体（抗dsDNA抗体,AnuA,抗DNP抗体和抗cmDNA抗体）水平的相关系数分别为（r=0.711,P〈0.05）、（r=0.845,P〈0.01）、（r=0.862,P〈0.01）和（r=0.724,P〈0.051）。结论：可溶性CD83通过活化DC细胞并激活补体系统,参与系统性红斑狼疮的发生发展,联合可溶性CD83和多种自身抗体的检测,能更明确系统性红斑狼疮患者病情的严重程度,有利于SLE的诊断和治疗。     

系统性红斑狼疮患者血清中CD83 与自身抗体的表达及其相互关系

目的:检测系统性红斑狼疮(systemic lupus erythematosus,SLE)患者血清中 CD83(soluble CD 83,sCD 83)和多种自身抗体的表达水平,并探讨其相互关系.方法:ELISA 检测患者可溶性 CD 83 和AnuA的表达,应用间接免疫荧光的方法检测抗cmDNA 抗体,应用乳凝法检测血清中的DNP,采用胶体金标记和快速膜渗滤技术测定血清中的抗 dsDNA 抗体.结果:对照组患者血清中可溶性 CD83 的表达为(0.26±0.10)ng/ml,实验组患者血清中可溶性 CD83 的表达为(5.56±0.72)ng/mI.与对照组相比,实验组患者血清中可溶性CD 83的平均浓度明显升高.在抗dsDNA抗体阴性的 51 例系统性红斑狼疮患者中 AnuA 的阳性率明显高于抗DNP 抗体和抗 cmDNA 抗体,同样在抗 DNP 抗体阴性的 58 例系统性红斑狼疮患者中 AnuA 的阳性率明显高于 dsDNA 抗体和抗 cmDNA 抗体.系统性红斑狼疮患者中可溶性 CD83 的水平(<2.68 ng/ml)与各种自身抗体(抗 dsDNA 抗体、AnuA、抗DNP抗体和抗 cmDNA 抗体) 水平的相关系数分别为(r＝0.542,0.613,0.489和0.367).具有高水平可溶性CD83的系统性红斑狼疮患者( ≥2.68 ng/ml),与各种自身抗体(抗dsDNA抗体,AnuA,抗 DNP 抗体和抗cmDNA 抗体)水平的相关系数分别为(r＝0.711,P<0.05)、(r＝0.845,P<0.01)、(r=0.862,P<0.01)和(r=0.724,P<0.051).结论:可溶性CD83通过活化DC细胞并激活补体系统,参与系统性红斑狼疮的发生发展,联合可溶性 CD83 和多种自身抗体的检测,能更明确系统性红斑狼疮患者病情的严重程度,有利于 SLE 的诊断和治疗.     

系统性红斑狼疮患者的心理分析和护理

系统性红斑狼疮(SLE)是一种常见的结缔组织病.可累及全身多系统的自身免疫性疾病,病程迁延,病情反复发作,免疫功能混乱是其主要发病机制.患者不稳定的心理状况直接导致病情不稳定及治疗效果.     

北京地区人群诺瓦克样病毒血清抗体水平调查

为了解诺瓦克样病毒在我国人群行情况。采用间接酶联免疫吸附法,分别以重组杆状病毒表达的Ｎｏｒｗａｌｋ（ｒＮＶ）和Ｍｅｉｘｃｏ（ｒＭＸ）病毒样颗粒为抗原,检测了北京地区１１０９份不同年龄人群血清标本中的特异性ＩｇＧ抗体。     

68例维吾尔族IgA肾病患者MBL基因多态性与临床病理相关性分析

目的探讨甘露糖结合凝集素（mannose—binding lectin,MBL）基因第54位密码子多态性与维吾尔族IgA肾病患者临床和病理的关系。方法应用PCR—RFLP方法对68例维吾尔族IgAN患者进行MBL多态性检测,并与患者临床和病理特点进行相关性分析。结果①维吾尔族IgAN中表现为蛋白尿的患者突变型等位基因GAC的发生频率显著高于表现为单纯血尿的患者（P〈0．05）;②维吾尔族IgAN中表现为复合性免疫沉积的患者等位基因GAC的发生频率显著高于表现为单纯免疫沉积的患者（P〈0．05）。结论MBL突变型等位基因GAC与维吾尔族IgAN蛋白尿发生和免疫复合沉积相关。     

健康教育对预防系统性红斑狼疮患者复发率的影响

目的 探讨健康教育对预防系统性红斑狼疮(SLE)患者复发的影响.方法 将2009~2010年我科收治行常规药物治疗和卫生宣教的128例SLE患者为对照组;将2011~2012 年收治行规范化治疗和连续系统的健康教育的136例SLE患者为观察组,即将健康教育贯穿于病人住院期间及出院后1年,根据病人不同时期的身心需求,实施连续系统的健康教育.结果 两组患者均病情好转出院,随访1年,观察组所有患者均坚持服药、建立良好生活方式、定期来院复查和化疗,仅3例病情复发,复发率为2.2%;对照组仅76%患者定期来院复查和化疗,复发16例,复发率为12.5%,明显高于观察组.结论 对SLE患者进行规范化治疗和连续系统的健康教育、定期随访,可有效的预防和减少SLE复发率及并发症发生率,提高患者生活质量.     

Spectroscopic diagnosis of anti-phospholipid antibodies by visible and near-infrared spectroscopy in SLE patients' plasma samples

The purpose of this study was to investigate whether visible and near-infrared (Vis-NIR) spectroscopy can be used for diagnoses of anti-phospholipid syndrome (APS). Vis-NIR spectra from 90 plasma samples [anti-phospholipid antibodies (aPLs)-positive group, n=48; aPLs-negative group, n=42] were subjected to principal component analysis (PCA) and soft independent modeling of class analogy (SIMCA) to develop multivariate models to discriminate between aPLs-positive and aPLs-negative. Both PCA and SIMCA models were further assessed by the prediction of 84 masked other determinations. The PCA model predicted successful discrimination of the masked samples with respect to aPLs-positive and aPLs-negative. The SIMCA model predicted 42 of 48 (87.5%) aPLs-positive patients and 33 of 36 (91.7%) aPLs-negative patients of Vis-NIR spectra from masked samples correctly. These results suggest that Vis-NIR spectroscopy combined with multivariate analysis could provide a promising tool to objectively diagnose APS.     

系统性红斑狼疮合并消化道损害32例临床分析

目的：探讨系统性红斑狼疮（SLE）合并消化道损害者的临床特点。方法：回顾性分析32例SLE合并消化道损害的患者,收集整理其临床资料,分析其临床特点。结果：食道受累者7例（21．9％）,胃肠道受累者25例（78．1％）其中假性肠梗阻10例（31．2％）,且以肠梗阻为首发症状的2例均误诊为急腹症收住外科,肾脏受累14例（43．8％）。治疗后,24例好转。4例死亡。结论：以消化道症状为首发表现的SLE极易误诊,特别是以吞咽障碍,肠梗阻为首发症状者最易误诊。对有消化道受损表现同时伴有其它脏器受损者应排除有无SLE可能。SLE消化道损害发生率高,对此应提高认识和警惕。     

The abnormal apoptosis of T cell subsets and possible involvement of IL-10 in systemic lupus erythematosus

To study the apoptosis of lymphocyte subpopulations in systemic lupus erythematosus (SLE) patients and the possible role of IL-10 in this apoptosis involved in the pathogenesis of SLE, three color fluorescence and flow cytometry were used to investigate the early apoptosis of lymphocyte subsets from freshly separated or cultured peripheral blood mononuclear cells (PBMCs). ELISA was employed to detect the levels of IL-10 in serum and the levels of sFas and sFasL in cultured PBMC supernatants, and the results of sFas and sFasL were confirmed by real-time PCR of Fas and FasL mRNA. The results showed that in cells from SLE patients, the apoptosis of CD3+, CD4+, and CD8+ T cells was distinctly increased, and the percentage of CD4+ cells and the CD4/CD8 ratio was significantly decreased, as compared with normal controls. The apoptosis of T lymphocytes cultured with SLE serum was markedly higher than that of cells cultured with control's serum. Blockade of interleukin-10 (IL-10) activation by an anti-IL-10 antibody reduced the SLE serum induced apoptosis of CD4+ and CD8+ T cells. The levels of sFas and sFasL in the culture supernatant and Fas and FasL mRNA expressions in cultured cells were significantly higher in the SLE serum-cultured groups, but decreased evidently in the presence of the anti-IL-10 antibody. Above findings suggested that SLE cells showed abnormally high apoptosis of T lymphocytes, especially of the CD4+ subpopulation, resulting in a decreased CD4/CD8 ratio. The high percentage of apoptotic T cells in SLE patients may be related to the high levels of IL-10 in SLE serum, as IL-10 may induce the abnormally activated T cells to trigger apoptosis via the Fas-FasL pathway.     

IL-17 与狼疮性肾炎关系的研究新进展

系统性红斑狼疮是一种涉及多系统损害的自身免疫性疾病,其主要并发症及死亡原因之一是狼疮性肾炎。研究表明,IL-17和产IL-17细胞可以浸润肾脏,与其他细胞因子协同作用,引起肾脏局部炎症反应。拮抗IL-17的生物制剂已应用于银屑病、强制性脊柱炎等免疫介导炎症性疾病,但在系统性红斑狼疮及狼疮性肾炎的研究尚少。本文对IL-17与狼疮性肾炎的关系进行综述,探讨IL-17及其抑制剂在狼疮性肾炎治疗的作用及发展前景。     

基于胶体金标记米曲霉素的免疫层析试纸法快速筛查SLE

建立基于胶体金标记米曲霉素(AOL)的快速筛查系统性红斑狼疮(SLE)的免疫层析试纸法。

利用大肠杆菌BL21原核表达特异性识别核心岩藻糖基的AOL基因(FleA), 并进行纯化及胶体金标记。利用特异性识别IgG的Protein G以及胶体金标记的AOL共同建立快速筛查SLE的免疫层析试纸法(ICS)。

成功表达并纯化AOL重组蛋白, 并进行胶体金标记; 应用胶体金标记AOL的ICS检测SLE患者血清呈阳性反应, 而健康对照及其他自身免疫性疾病(类风湿关节炎、IgA肾病和结缔组织病等)呈阴性反应。

成功建立基于胶体金标记AOL的快速筛查SLE的ICS, 为SLE早期筛查提供了可靠依据。

     

精神分裂症患者甘露糖结合凝集素基因启动子区多态性及血清浓度的研究

目的:探讨精神分裂症患者甘露糖结合凝集素(MBL)的血清浓度和启动子区基因多态性的相关性及在患者免疫病理机制中的作用。方法:选取2018年6月至2018年12月在我院就诊的精神分裂患者为54例为观察组,另选取同时期本院健康体检中心志愿者56例为正常对照组,采用合酶链反应-序列特异性引物(PCR-SSP)技术分析MBL基因启动子区H/L(-550bp G/C)和X/Y(-221bp C/G)的多态性,酶联免疫吸附法(ELISA)检测血清MBL的浓度。结果:观察组血清MBL浓度(1367.218±1277.429)ng/mL低于正常对照组(1987.781±976.748)ng/mL,差异有统计学意义(P0.05)。观察组HY/HY基因型频率低于对照组(P0.05),HY/LY型频率高于对照组(P0.05)。观察组HY/HY基因型血清MBL浓度明显高于HY/LX、LY/LX型(P0.05);观察组MBL基因启动子区突变型纯合子的血清MBL水平均与对照组差异无统计学意义(P0.05),而MBL基因型杂合子的MBL水平则差异有统计学意义(P0.05)。结论:精神分裂症患者MBL水平低下与患者MBL基因启动子区各基因型的综合调控有关。MBL浓度低下是精神分裂症患者循环免疫复合物(CIC)滞留或清除障碍的分子机制之一。     

Defects of mitogen-activated protein kinase in ICOS signaling pathway lead to CD4 and CD8 T-cell dysfunction in patients with active SLE

In this study, hypoproliferation and defects of effectors and cytokines in CD4⁺ and CD8⁺ T-cells via ICOS costimulation were found in active SLE patients, relative to normal individuals and RA patient controls. Exogenous IL-2 can partially reverse those defects. In addition, low level of ERK phosphorylation in ICOS-mediated signaling pathway was discovered in lupus CD4⁺ and CD8⁺ T-cells. When blocked with ERK-specific chemical inhibitor PD98059, cell proliferation and IL-2 production via ICOS costimulation from both CD4⁺ and CD8⁺ T-cells will be severely inhibited. These findings confirmed the dysfunction of both CD4⁺ and CD8⁺ T-cells after ICOS costimulation in lupus patients and most importantly pointed out that impairment of ERK activation might be one of the critical factors involved in ICOS-mediated IL-2 and T-cell hypoproliferation in active SLE.     

儿童系统性红斑狼疮合并感染86例的临床分析

目的:探讨感染对儿童初发系统性红斑狼疮病情活动度的影响。方法:通过回顾性研究收集儿童系统性红斑狼疮病例86例,通过整理病史、体格检查及统计实验室检查结果等方法统计相关临床及实验室资料。根据以上资料分为感染组和对照组,通过比较分析两组资料探讨感染对初发儿童SLE病情活动度的影响情况。结果:1)SLE患儿感染发生率为52.3%,感染部位以呼吸道多见,占40%,其次为消化道和泌尿道,病原体以细菌多见,占62.2%,其次为支原体、病毒;2)感染组的ds-DNA、CD3~+CD8~+(Ts)细胞、CD3~-CD19~+(B)细胞、SLEDAI评分均明显高于对照组(P0.05);感染组补体数量明显低于对照组(P0.05),感染组抗感染治疗后,ds-DNA、CD3~+CD8~+(Ts)细胞、SLEDAI评分较治疗前明显下降(P0.05),而补体数量及CD3~-CD16~+CD56~+(%)细胞较治疗前明显上升(P0.05)。结论:儿童SLE患者较易合并感染,发病初期及合并感染会加重儿童系统性红斑狼疮的病情,及时有效控制感染有助于改善儿童SLE患者的病情。     

SLE血清中抗-DNA抗体分离和性质的研究

本文用国产高分子树脂(T)接枝小牛胸腺DNA,通过亲合层析从系统性红斑狼疮SLE患者血清中纯化出抗-ds DNA抗体和抗-ss DNA抗体。酶联免疫吸附分析(ELISA)的研究表明:SLE抗-DNA抗体和DNA结合的差异性很大,是高度非均一性的。抗-ss DNA抗体不仅组成成分比抗-ds DNA抗体复杂,ss DNA/抗-ssDNA亲合能力也明显高于ds DNA/抗-ds DNA。纯化的抗-DNA抗体以IgG类抗体占主导,同时也有其它类型抗体存在(例如IgM等)。抗-ds DNA抗体有较抗-ss DNA抗体高的IgG含量(两者的IgG/IgM分别是7.0和4.0),说明IgG抗-DNA抗体更倾向于同dsDNA结合。     

Predictors of clinical outcomes in patients with neuropsychiatric systemic lupus erythematosus

IntroductionNeuropsychiatric systemic lupus erythematosus (NPSLE), a serious organ disorder with a variety of symptoms, has diverse therapeutic outcomes because of the variability of NPSLE manifestations. A comprehensive association study of NPSLE among clinical and immunopathogenic aspects and outcomes has not been conducted.MethodsWe analyzed the laboratory data, NPSLE symptoms, and clinical outcomes at 1 yr post-treatment and the profiles of 27 cytokines, chemokines and growth factors in cerebrospinal fluid (CSF) samples using the Bio-Plex Human 27-plex panel from 28 NPSLE patients. Univariate and multivariable competing risks regression analyses were used to determine the predictive factors of clinical response. We also tried to predict the outcome of NPSLE by the 27 cytokines/chemokines/growth factors using a weighted-voting (WV) algorithm.ResultsOf the two males and 26 females (92.9%), 16 were non-responders at 1 yr post-treatment; in the final model, the independent predictors of non-responders were longer disease durations of SLE (odds ratio [OR]: 1.490, 95% confidence interval [CI]: 1.143–2.461, p = 0.0003) and patients with more than one NPSLE symptom types (OR: 15.14, 95% CI: 1.227–452.1, p = 0.0334). The pretreatment CSF interleukin (IL)-6, IL-10, interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α) levels were significantly higher in the non-responders (p = 0.0207, p = 0.0054, p = 0.0242 and p = 0.0077, respectively). We identified six “minimum predictive markers:” IL-10, TNF-α, IL-6, IFN-γ, IL-4 and IL-13 by a WV algorithm that showed the highest accuracy (70.83%) and highest Matthews correlation coefficient (54.23%).ConclusionsWe have devised a numerical prediction scoring system that was able to separate the non-responders from responders. The patients with longer disease durations of SLE and those with more than one NPSLE symptom types had poorer outcomes. Our findings may indicate both the importance of making a diagnosis at an earlier phase for better therapeutic response and the usefulness of measuring multiple cytokines to predict NPSLE therapeutic outcomes.