系统性红斑狼疮患者外周血T淋巴细胞亚群的分布及其与疾病活动和预后的关系

doi:10.13481/j.1671-587x.20190637

摘要/Abstract

摘要： 目的：分析系统性红斑狼疮（SLE）患者外周血中T淋巴细胞亚群的分布，并阐明其与SLE疾病活动性及预后的关系。方法：收集100例初治SLE患者外周血，分析不同临床亚型SLE患者（肾脏受累、皮肤受累、关节受累、血液系统受累和不同疾病活动期） T淋巴细胞亚群计数，评估初治SLE患者基线期临床指标与T淋巴细胞亚群计数之间的关系。100例患者中有78例随访12个月，随访患者中26例出现不良预后，比较预后不良组与临床缓解组SLE患者T淋巴细胞亚群计数；SLE患者T淋巴细胞亚群计数与临床指标的相关性分析采用Spearman相关分析。结果：狼疮肾炎组SLE患者CD3+T淋巴细胞、CD4+T淋巴细胞和CD8+T淋巴细胞计数低于非狼疮肾炎组（P<0.05），关节受累组SLE患者CD3+T淋巴细胞、CD4+T淋巴细胞计数低于非关节受累组（P<0.05），皮肤受累组SLE患者CD8+T淋巴细胞计数低于非皮肤受累组（P<0.05），血液系统受累组SLE患者CD3+T淋巴细胞、CD4+T淋巴细胞和CD8+T淋巴细胞计数低于非血液系统受累组（P<0.05）。SLE患者基线水平CD3+T淋巴细胞、CD4+T淋巴细胞和CD8+T淋巴细胞计数与SLE疾病活动性指标（SLEDAI）评分呈负相关关系（r=-0.391，P=0.001；r=-0.360，P=0.002；r=-0.315，P=0.008）；CD3+T淋巴细胞、CD4+T淋巴细胞、CD8+T淋巴细胞计数与SLE患者血浆C3水平呈正相关关系（r=0.407，P=0.001；r=0.395，P=0.001；r=0.254，P=0.035）；CD3+T淋巴细胞、CD4+T淋巴细胞和CD8+T淋巴细胞计数与SLE患者外周血淋巴细胞（LY）计数呈正相关关系（r=0.717，P=0.000；r=0.617，P=0.000；r=0.599，P=0.000）；重度活动组SLE患者CD3+T淋巴细胞、CD4+T淋巴细胞和CD8+T淋巴细胞计数低于轻度活动组（P<0.05）；预后不良组SLE患者CD3+T淋巴细胞和CD4+T淋巴细胞计数于临床缓解组（P<0.05）。结论：T淋巴细胞亚群分布在不同亚组SLE患者中各有不同，并且与SLE疾病活动性密切关联；CD4+T淋巴细胞计数与SLE患者预后不良有关，有可能成为SLE疾病活动性标志物和预后判断的标志物。

关键词: 系统性红斑狼疮, T淋巴细胞亚群, 疾病活动性, 预后不良

Abstract: Objective: To analyze the distribution of T lymphocyte subsets in peripheral blood of the systemic lupus erythematosus(SLE) patients, and to clarify its relationships with SLE disease activity and prognosis. Methods: The peripheral blood of 100 patients with primary SLE was collected, the counts of T lymphocyte subsets in the patients with different clinical subtypes of SLE (kidney involvement, skin involvement, joint involvement,hematological system involvement and different disease activity stages) were analyzed, and the relationships between the clinical indexes and the T lymphocyte subsets in the patients with primary SLE at baseline were evaluated.A total of 78 among 100 patients were followed up for 12 months, among them 26 patients had poor prognosis;the counts of T lymphocyte subsets in the patients with SLE were compared between poor prognosis group and clinical remission group. The correlations between the counts of T lymphocyte subsets in the SLE patients and the clinical indexes were analyzed by Spearman correlation test. Results: The counts of CD3+ T lymphocytes, CD4+ T lymphocytes and CD8+ T lymphocytes of the SLE patients in lupus nephritis group were lower than those in non-lupus nephritis group (P<0.05), the counts of CD3+ T lymphocytes and CD4+ T lymphocytes in the SLE patients in joint involvement group were lower than those in non-joint involvement group (P<0.05), the count of CD8+ T lymphocytes of the SLE patients in skin involvement group was lower than that in non-skin involvement group (P<0.05), and the counts of CD3+ T lymphocytes,CD4+ T lymphocytes and CD8+ T lymphocytes of the SLE patients in hematological system involvement group were lower than those in non- hematological system involvement group (P<0.05). The counts of CD3+ T lymphocytes, CD4+ T lymphocytes, and CD8+ T lymphocytes of the SLE patients were negatively correlated with the SLE disease activity index(SLEDAI) score (r=-0.391, P=0.001; r=-0.360, P=0.002; r=-0.315, P=0.008); the counts of CD3+ T lymphocytes, CD4+ T lymphocytes,and CD8+ T lymphocytes were positively correlated with the plasma C3 level of the SLE patients (r=0.407, P=0.001; r=0.395, P=0.001; r=0.254, P=0.035); the counts of CD3+ T lymphocytes, CD4+ T lymphocytes, and CD8+ T lymphocytes were positively correlated with the lymphocyte (LY) level in peripheral blood of the SLE patients (r=0.717,P=0.000;r=0.617,P=0.000;r=0.599,P=0.000);the counts of CD3+ T lymphocytes, CD4+ T lymphocytes, and CD8+ T lymphocytes of the SLE patients in severe activity group were significantly lower than those in mild activity group(P<0.05);the counts of CD3+ T lymphocytes and CD4+ T lymphocytes of the SLE patients in poor prognosis group were lower than those in clinical remission group (P<0.05). Conclusion: The distribution of T lymphocyte subsets of the SLE patients in different subgroups is different, and it is closely associated with the SLE disease activity;the low count of CD4+T lymphocytes is associated with the poor prognosis of SLE patients, which may be a marker of SLE disease activity and prognostic judgment.

Key words: systemic lupus erythematosus, T lymphocyte subsets, disease activity, poor prognosis

中图分类号:

R593.24

冯秀南, 袁艺, 宿凯笙, 姜振宇. 系统性红斑狼疮患者外周血T淋巴细胞亚群的分布及其与疾病活动和预后的关系[J]. 吉林大学学报(医学版), 2019, 45(06): 1415-1421.

FENG Xiunan, YUAN Yi, SU Kaisheng, JIANG Zhenyu. Distribution of peripheral blood T lymphocyte subsets of patients with systemic lupus erythematosus and its relationships with disease activity and prognosis[J]. Journal of Jilin University(Medicine Edition), 2019, 45(06): 1415-1421.

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