新诊断轻度活动的系统性红斑狼疮病人免疫及血管内皮功能的改变研究
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摘要
目的探讨新诊断轻度活动的系统性红斑狼疮病人免疫及血管内皮功能的改变及其关系。方法选择2014年3月至2016年10月在江门市五邑中医院新诊断为轻度活动系统性红斑狼疮病人72例(SLE组),另选择同期进行健康体检者30例作为对照组,采用酶联免疫吸附实验法检测两组受检者外周血清中一氧化氮(NO)、内皮素1-(ET-1)、超敏C反应蛋白(hs-CRP)、γ-干扰素(IFN-γ)、肿瘤坏死因子-α(TNF-α)及白细胞介素4(IL-4)含量,同时利用超声检测肱动脉血流介导的内皮依赖性血管舒张功能(FMD),并与对照组相比。结果 SLE组病人中ET-1、hs-CRP、IFN-γ、TNF-α水平分别为(169.26±10.42)pg/mL、(20.17±4.37) mg/L、(12.83±2.36)ng/L、(36.67±5.17)pg/mL,均较对照组明显升高(均P<0.05),NO[(23.62±3.68)μmol/L]、FMD[(7.62%±1.47%)]及IL-4[(7.76±2.31)pg/mL]水平下降(均P<0.05),FMD与hs-CRP、IFN-γ、TNF-α呈显著负相关(r=-0.37,-0.43,-0.40;P<0.05)。结论新诊断的轻度活动的系统性红斑狼疮病人即存在内皮功能障碍,其发生与炎症密切相关,Th1和Th2两类细胞因子的失衡参与了系统性红斑狼疮所致的内皮功能障碍的发生。
Objective To explore the changes of immune and vascular endothelial function in patients with newly diagnosed mild active systemic lupus erythematosus,and to investigate the correlation between immune and vascular endothelial function.Methods Seventy-two patients with newly diagnosed mild active systemic lupus erythematosus treated in The Wuyi Hospital of Traditional Chinese Medicine from March 2014 to October 2016 were enrolled in the study and the other 30 healthy subjects who received health checkup during the same period were selected as control group.Enzyme-linked immunosorbent assay(ELISA) was used to measure the contents of nitric oxide(NO),endothelin-1(ET-1),hyper-sensitive C-reactive protein(hs-CRP),interferon-γ(IFN-γ),tumor necrosis factor(TNF-α),and interleukin-4(IL-4) in peripheral serum of the two groups.The endothelium-dependent flow-mediated dilatation(FMD) mediated by brachial artery flow was determined with ultrasound and comparison was madebetween the two groups.Results The levels of ET-1 [(169.26±10.42) pg/mL],hs-CRP [(20.17±4.37) mg/L],IFN-γ [(12.83±2.36)ng/L],and TNF-α [(36.67±5.17) pg/mL] in the SLE group were significantly higher than those in the control group(all P<0.05);the levels of NO [(23.62±3.68) μmol/L],FMD [(7.62%±1.47%)],and IL-4 [(7.76±2.31) pg/mL] in the SLE group were lower than those in the control group(all P<0.05).FMD was negatively correlated with hs-CRP,IFN-γ,and TNF-α(r=-0.37,-0.43 and-0.40,respectively,P<0.05).Conclusion Endothelial dysfunction is present in patients with newly diagnosed mild active systemic lupus erythematosus.Its occurrence is closely related to inflammation.The imbalance between the Th1 and Th2 is involved in the development of endothelial dysfunction caused by systemic lupus erythematosus.
Objective To explore the changes of immune and vascular endothelial function in patients with newly diagnosed mild active systemic lupus erythematosus,and to investigate the correlation between immune and vascular endothelial function.Methods Seventy-two patients with newly diagnosed mild active systemic lupus erythematosus treated in The Wuyi Hospital of Traditional Chinese Medicine from March 2014 to October 2016 were enrolled in the study and the other 30 healthy subjects who received health checkup during the same period were selected as control group.Enzyme-linked immunosorbent assay(ELISA) was used to measure the contents of nitric oxide(NO),endothelin-1(ET-1),hyper-sensitive C-reactive protein(hs-CRP),interferon-γ(IFN-γ),tumor necrosis factor(TNF-α),and interleukin-4(IL-4) in peripheral serum of the two groups.The endothelium-dependent flow-mediated dilatation(FMD) mediated by brachial artery flow was determined with ultrasound and comparison was madebetween the two groups.Results The levels of ET-1 [(169.26±10.42) pg/mL],hs-CRP [(20.17±4.37) mg/L],IFN-γ [(12.83±2.36)ng/L],and TNF-α [(36.67±5.17) pg/mL] in the SLE group were significantly higher than those in the control group(all P<0.05);the levels of NO [(23.62±3.68) μmol/L],FMD [(7.62%±1.47%)],and IL-4 [(7.76±2.31) pg/mL] in the SLE group were lower than those in the control group(all P<0.05).FMD was negatively correlated with hs-CRP,IFN-γ,and TNF-α(r=-0.37,-0.43 and-0.40,respectively,P<0.05).Conclusion Endothelial dysfunction is present in patients with newly diagnosed mild active systemic lupus erythematosus.Its occurrence is closely related to inflammation.The imbalance between the Th1 and Th2 is involved in the development of endothelial dysfunction caused by systemic lupus erythematosus.
引文
[1]常文静,蔡辉.系统性红斑狼疮早发动脉粥样硬化机制的研究进展[J].安徽医药,2014,18(9):1617-1621.
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[4] GUSTAFSSON JT,SIMARD JF,GUNNARSSON I,et al. Risk factors for cardiovascular mortality in patients with systemic lupus erythematosus,a prospective cohort study[J]. Arthritis Res Ther,2012,14(2):R46.
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[6] ATEHORT U'A L,ROJAS M,VSQUEZ GM,et al. Endothelial alterations in systemic lupus erythematosus and rheumatoid arthritis:potential effect of monocyte interaction[J]. Mediators Inflamm,2017,2017:9680729.
[7] LIMA DS,SATO EI,LIMA VC,et al. Brachial endothelial function is impaired in patients with systemic lupus erythematosus[J]. J Rheumatol,2002,29(2):292-297.
[8]唐晓晏,申子刚,张志仁.炎症消退障碍与动脉粥样硬化不稳定斑块形成[J].免疫学杂志,2017,33(4):364-368.
[9]赵珊,俞娟,张虹.系统性红斑狼疮合并冠状动脉性心脏病患者Th1/Th2失衡的研究[J].重庆医学,2016,45(2):216-218,222.
[10] POIROUX L,ALLANORE Y,KAHAN A,et al. All-cause mortality associated with TNF-αinhibitors in rheumatoid arthritis:a meta-analysis of randomized controlled trials[J]. Am J Med,2015,128(12):1367-1373.
[11] LIU ZP,WANG JJ,HUANG EW,et al. Tanshinone IIA suppresses cholesterol accumulation in human macrophages:role of heme oxygenase-1[J]. J Lipid Res,2014,55(2):201-213.
[2] GISTERA,HANSSON GK. The immunology of atherosclerosis[J]. Nat Rev Nephrol,2017,13(6):368-380.
[3]王秀芬,崔姝雅,叶子芯,等.一氧化氮在动脉粥样硬化发病机制中作用的研究进展[J].中国老年学杂志,2016,36(21):5459-5462.
[4] GUSTAFSSON JT,SIMARD JF,GUNNARSSON I,et al. Risk factors for cardiovascular mortality in patients with systemic lupus erythematosus,a prospective cohort study[J]. Arthritis Res Ther,2012,14(2):R46.
[5] KAO AH,WASKO MC,KRISHNASWAMI S,et al. C-reactive protein and coronary artery calcium in asymptomatic women with systemic lupus erythematosus or rheumatoid arthritis[J]. Am J Cardiol,2008,102(6):755-760.
[6] ATEHORT U'A L,ROJAS M,VSQUEZ GM,et al. Endothelial alterations in systemic lupus erythematosus and rheumatoid arthritis:potential effect of monocyte interaction[J]. Mediators Inflamm,2017,2017:9680729.
[7] LIMA DS,SATO EI,LIMA VC,et al. Brachial endothelial function is impaired in patients with systemic lupus erythematosus[J]. J Rheumatol,2002,29(2):292-297.
[8]唐晓晏,申子刚,张志仁.炎症消退障碍与动脉粥样硬化不稳定斑块形成[J].免疫学杂志,2017,33(4):364-368.
[9]赵珊,俞娟,张虹.系统性红斑狼疮合并冠状动脉性心脏病患者Th1/Th2失衡的研究[J].重庆医学,2016,45(2):216-218,222.
[10] POIROUX L,ALLANORE Y,KAHAN A,et al. All-cause mortality associated with TNF-αinhibitors in rheumatoid arthritis:a meta-analysis of randomized controlled trials[J]. Am J Med,2015,128(12):1367-1373.
[11] LIU ZP,WANG JJ,HUANG EW,et al. Tanshinone IIA suppresses cholesterol accumulation in human macrophages:role of heme oxygenase-1[J]. J Lipid Res,2014,55(2):201-213.