系统性红斑狼疮患者关节功能及外周血单个核细胞变化与来氟米特的干预  

Intervention of leflunomide therapy on joint function and changes of peripheral blood mononuclear cells in patients with systemic lupus erythematosus

作　　者：李英楠[1] 张凤山[1] 李露露[1] 于慧敏[1] 聂英坤[1] 

机构地区：[1]哈尔滨医科大学附属第二医院风湿科,黑龙江省哈尔滨市150086

出　　处：《中国临床康复》2005年第31期116-118,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:探讨来氟米特治疗对系统性红斑狼疮关节炎患者关节肿痛、功能障碍的恢复作用,及对外周血单个核细胞程序性细胞死亡1的表达、血清中干扰素诱导蛋白10水平的调节作用。方法:①选择2004-01/05院风湿科门诊及住院系统性红斑狼疮患者36例,男2例,女34例,平均(32±12)岁。系统性红斑狼疮疾病活动性积分(0～4分:基本无活动;5～9分:轻度活动;10～14分:中度活动;≥15分:重度活动)为10～23分,均为活动期并伴有关节炎表现。随机将患者分成2组:激素组17例,激素+来氟米特组19例。选择同期本院健康体检者21人为对照组,男4例,女17例;年龄20～45岁。纳入对象均知情同意。②记录治疗前后关节肿胀、疼痛指数、系统性红斑狼疮疾病活动性积分,同时用流式细胞仪测定治疗前后患者和21例正常人外周血淋巴细胞、粒细胞程序性细胞死亡1的表达,血清中干扰素诱导蛋白10的水平采用酶联免疫吸附测定法检测,血清中抗核抗体滴度采用间接免疫荧光法检测,抗双链DNA(ds-DNA)水平采用放射免疫法检测。分析活动期淋巴细胞程序性细胞死亡1表达、干扰素诱导蛋白10水平与抗ds-DNA抗体、系统性红斑狼疮疾病活动性积分的相关性。③两组间差异显著性检验采用两独立样本的t检验,并用直线相关分析检测样本间的相关性。结果:系统性红斑狼疮患者36例,健康者21人均进入结果分析。①关节压痛指数、关节肿胀指数、关节疼痛指数、血沉:激素+来氟米特组和激素组治疗后均明显低于治疗前(t=4.403～8.008,P<0.01),激素+来氟米特组治疗后明显低于激素组治疗后(t=4.460,3.716,3.908,4.719,P<0.01)。②外周血淋巴细胞程序性细胞死亡1、干扰素诱导蛋白10水平:激素+来氟米特组和激素组治疗前明显高于对照组(t=4.767～5.536,P<0.01);激素+来氟米特组和激素组治疗后明显低于治疗前(t=7.011,4.434,6.157,3.705,P<0.01AIM： To explore the recovery efficacy of leflunomide （LEF） therapy on the joint swelling ache and dysfunction, and regulation role of the expression of programmed cell death-1 （PDCD-1） on peripheral blood mononuclear cells （PBMCs） and serum interferon inducible protein-10 （IP-10） in patients with systemic lupus erythematosus arthritis （SLEA）. METHODS： ① Thirty-six patients with systemic lupus erythematosus, who were treated at the Department of Rheumatology and hospitalization from January to May 2004,were selected, including 2 males and 34 females, aged （32±12） years old averagely. The systemic lupus erythematosus disease activity index （SLEDAI） were ranged 10-23 points （0-4 points ： no activity ; 5-9 points ： mild activity ; 10-14 points ：moderate activity; ≥ 15 points：Severe activity）, and the patients were all in the active phase with arthritis. They were randomly divided into 2 groups： hormones group with 17 cases, and hormones＋leflunomide group with 19 cases. Twenty-one healthy testees in this hospital at synchronization were selected as control group, including 4 males and 17 females, aged from 20 to 45 years old. All the subjects were permission. ② The clinical parameters including the index of swelling, tenderness and SLEDAI were recorded before and after treatment. Meanwhile, the expression of PDCD-1 on PBMCs was tested by flow cytometry, and the level of serum IP-10 was tested with enzyme-linked immunosorbent assay （ELISA） in SLE patients and 21 healthy controls before and after treatment. The titre of antinuclear antibody （ANA） in serum and ds-DNA antibodys were determined by indirected immunofluorescence and radioimmunity,respectively. The association between the expression of PDCD-1 on active patients lymphocyte, the level of IP-10 in active patients and ds-DNA antibody, SLEDAI was analyzed. ③ The significance of inter-group difference was analyzed by the independent sample t-test, and the correlation of intersample was detected by the

关 键 词：红斑狼疮 系统性 来氟米特 关节炎/药物疗法 

分 类 号：R57[医药卫生—消化系统]