重症狼疮肾炎患者血清TNF-α与sTNF-R水平及甲泼尼龙与环磷酰胺双冲击治疗对其的影响  

The levels of serum tumor necrosis factor-alpha and soluble tumor necrosis factor receptor of patients with severe lupus nephritis and the effect of double pulse therapy with methylprednisolone combined cytoxan on them

作　　者：夏成云[1] 周京国[1] 张国元[2] 

机构地区：[1]川北医学院附属医院内科,南充637000 [2]川北医学院附属医院检验科,南充637000

出　　处：《中华风湿病学杂志》2006年第2期91-94,共4页Chinese Journal of Rheumatology

基　　金：四川省卫生厅科研基金资助项目(020025)

摘　　要：目的探讨重症狼疮肾炎(SLN)患者血清肿瘤坏死因子!(TNF-!)、可溶性肿瘤坏死因子受体(sTNF-R)的水平、sTNF-R/TNF-!比值及甲泼尼龙(MP)与环磷酰胺(CTX)双冲击治疗对其的影响。方法采用双抗体夹心酶联免疫吸附试验(ELISA)检测35名健康人(正常对照组)和38例SLN患者经MP与CTX双冲击治疗前后血清TNF-!、sTNF-RⅠ、sTNF-RⅡ的水平;抗双链DNA抗体采用ELISA法测定;抗核抗体采用间接免疫荧光法检测;补体C3、C4含量采用速率散射比浊法测定。结果SLN患者血清中TNF-!、sTNF-RⅠ、sTNF-RⅡ水平及TNF-!/sTNF-RⅠ、TNF-!/sTNF-RⅡ比值均显著高于正常对照组(P<0.01),且sTNF-RⅡ增高幅度明显高于sTNF-RⅠ(P<0.01),TNF-!、sTNF-RⅠ、sTNF-RⅡ水平与系统性红斑狼疮疾病活动指数(SLEDAI)评分、抗核抗体、抗双链DNA抗体、血沉、24h尿蛋白定量、血尿素氮(BUN)、血肌酐(Scr)呈显著正相关(P<0.05或P<0.01),与补体C3、C4、内生肌酐清除率(Ccr)呈显著负相关(P<0.05或P<0.01);sTNF-RⅠ与sTNF-RⅡ之间呈显著正相关(P<0.01)。MP与CTX双冲击治疗能显著降低SLN患者血清TNF-!、sTNF-RⅠ、sTNF-RⅡ水平及sTNF-RⅠ/TNF-!、sTNF-RⅡ/TNF-!比值(P<0.01)。结论TNF-!、sTNF-R参与了SLN的发病过程,血清TNF-!、sTNF-RⅠ、sTNF-RⅡ在一定程度上可反映SLN患者肾脏损害程度、病情轻重。动态观察血清TNF-!、sTNF-RⅠ、sTNF-RⅡ水平及sTNF-R/TNF-!比值,有助于判断SLN的狼疮活动、治疗效果及预后。MP与CTX双冲击疗法可能通过抑制SLN患者单核/巨噬细胞、T细胞产生TNF-!而发挥治疗作用。Objective To investigate the levels of serum tumor necrosis factor-alpha （TNF-α） and soluble tumor necrosis factor receptor （sTNF-R） and sTNF-R/TNF-α ratios in patients with severe lupus nephritis （SLN） and the impact of double pulse therapy with methylprednisolone （MP） combined cytoxan （CTX）. Methods Serum TNF-α, soluble tumor necrosis factor receptor typeⅠ （sTNF-R Ⅰ ） and soluble tumor necrosis factor receptor typeⅡ （sTNF-RⅡ ） levels were determined in 38 cases of SLN patients and 35 health controls by double antibody sandwich enzyme-linked immunosorbent assay （ELISA） before and after the doubie pulse therapy with MP and CTX. Anti-dsDNA antibody was detected by ELISA. Antinuclear antibody （ANA） was detected by indirect immunofluorescence experiments. Complement C3 and complement C4 were detected by rate nephelometry. Results The serum levels of TNF-a, sTNF-RⅠ, sTNF-R Ⅱ and ratios of TNF-a/sTNF-RⅠ, TNF-a/sTNF-RⅡ were significantly higher in SLN patients than those in normal control group （P〈O.01）, sTNF-RⅡ was significantly higher than sTNF-R Ⅰ（P〈O.OI）. There was significant positive correlation between the levels of sTNF-R Ⅰ and sTNF-RⅡ, and serum levels of TNF-a, sTNF-RⅠ , sTNF-R Ⅱ in the SLN patients were evidently correlated with the systemic lupus erythematosus disease activity index （SLEDAI） score, ANA, anti-dsDNA antibody , erythrocyte sedimentation rate （ESR）, 24-hour urinary proteninura, blood urea nitrogen （BUN） and serum creatinine （Scr） （P〈O.05 or P〈O.O1）, and negatively correlated with complement C3, complement C4 and endogenous creatinine clearance rate （Ccr） （P〈O.01 or P〈0.05）. There was a significant positively correlation between the levels of sTNF-RⅠ and sTNF-RⅡ （P〈 0.01）. In patients with SLN treated with the double pulse therapy with MP and CTX, the serum levels of TNF- a, sTNF-R Ⅰ, sTNF-RⅡ and ratios of TNF-a/sTNF RⅠ , TNF-a/sTNF-RⅡ post-treatment were obvious

关 键 词：狼疮肾炎 肿瘤坏死因子α 可溶性肿瘤坏死因子受体 甲泼尼龙 环磷酰胺 

分 类 号：R593.242[医药卫生—内科学]