外周Th17／Treg和白细胞介素17与狼疮肾炎临床病理的相关性研究  

Levels of IL-17 and Th17/Treg ratio reflect clinical and pathological activity in patients with lupus nephritis

作　　者：许嵘[1] 钟一红[1] 丁小强[1] 方艺[1] 卢泽军[1] 张慧[1] 刘少鹏[1] 朱加明[1] 

机构地区：[1]复旦大学附属中山医院肾内科许嵘现在江苏省中医院肾内科,上海200032

出　　处：《中华肾脏病杂志》2014年第4期247-253,共7页Chinese Journal of Nephrology

基　　金：上海市科委基础研究重点项目（08JC1404300）

摘　　要：目的阐明狼疮肾炎（LN）患者外周血辅助性T细胞17／调节性T细胞（Th17／Treg）及白细胞介素（IL）17与临床病理的相关关系。方法以2011年6月至2012年2月在复旦大学附属中山医院肾内科就诊的LN患者为研究对象，记录其人口学、临床指标和病理指数等资料。流式细胞术检测外周血Th17、Treg细胞所占比例，计算Th17／Treg比值；ELISA法检测外周血IL．17等细胞因子水平。结果60例LN患者被纳入研究，SLE疾病活动指数（SLEDAI）为9．50±4．61。LN患者（活动组＋非活动组）Th17／Treg比值明显高于健康对照组[（0．95±0．67）比（0．29＋0．13），P〈0．05]；LN活动组Th17／Treg比值明显高于LN非活动组[（1．33±0．71）比（0．57±0．33），P〈0．01]。LN患者外周血Th17／Treg比值与SLEDAI呈正相关（r=0．650，P〈0．01），与。肾脏病理活动指数（AI）呈正相关（r=0．675，P〈0．01）。血清IL-10水平与SLEDAI呈负相关（r=-0．567，P〈0．01），与AI呈负相关（r=-0．422，P〈0．01）；血清IL．17水平与SLEDAI呈正相关（r=0．559，P〈0．01），与AI呈正相关（r=0．479，P〈0．01）；血清IL．23水平与SLEDAI呈正相关（r=0．339，P〈0．05），与AI呈正相关（r=0．350，P〈0．05）。LN患者血清抗ds—DNA抗体水平和c3水平与SLEDAI和AI评分均无相关性（P〉0．05）。以SLEDAI≥10作为诊断LN临床病情活动标准。Th17／Treg、IL-17和IL．23的ROC曲线下面积分别为0．92（0．83～1．00）、0．91（0．81—1．00）和0．67（O．51—0．83）；以AI〉8分作为诊断LN病理活动标准，Th17／Treg和IL-17的ROC曲线下面积分别为0．87（0．76～0．99）和0．84（0．69—0．99）。结论外周血Th17／Treg比值和IL．17水平与LN患者临床病理活动的相关度高于血清抗ds．DNA抗体、c3及IL-10、IL．23等指标；血清IL-10、IL．23水平与LN临床病理的相关度高于血清抗ds．DNA抗体Objective To explore the correlation of Thl7/Treg ratio and related cytokines with clinical and pathological activity in patients with lupus nephritis （LN）. Methods The patients with lupus nephritis were enrolled into this study from June 2011 to Feb 2012. The demographic data, clinical activity and pathological index were recorded and analyzed in details. The frequency of Thl7 and Treg in peripheral blood CD4＋ T lymphocytes was tested by flow cytometry and the ratio of Thl7 to Treg was calculated. The levels of such cytokines as IL-6, IL-10, IL-17, IL-23, TGF-I were detected by ELISA. Results A total of 60 patients with LN were enrolled in this study. Of them, 90% were female, 10% were male, the average age was （36.39±14.23） （14-75） years old, the duration was 1.00 （0.33±9.25） years, the average SLEDAI was （9.50±4.61）. Compared with control group, the ratio of Thl7to Treg in LN group was significantly higher [（0.95±0.67） vs （0.29±0.13）, P 〈 0.05]; further the Th17/ Treg ratio in active LN group was much higher [（1.33±0.71） vs （0.57±0.33）, P 〈 0.01] compared with inactive LN group. The ration of Thl7 to Treg was positively correlated with SLEDAI and AI （r = 0.650, P 〈 0.01; r = 0.675, P 〈 0.01）. The level of serum IL-10 was negatively correlated with SLEDAI and AI （r = -0.567, P 〈 0.01; r = -0.422, P 〈 0.01）. The level of serum IL - 17 was positively correlated with SLEDAI and AI （r = 0.559, P 〈 0.01; r = 0.479, P 〈 0.01）. The level of IL-23 was positively correlated with SLEDAI and AI （r = 0.339, P 〈 0.05; r = 0.350, P 〈 0.05）. The levels of serum anti - dsDNA and C3 were not correlated with SLEDAI and AI in patients with LN （P 〈 0.01）. As the diagnostic indicator of active LN（SLEDAI〉 10）, the AUCs of Thl7/Treg, IL-17, IL-23 were 0.92 （0.83-1.00）, 0.91 （0.81- 1.00） and 0.67（0.51-0.83）, respectively. As the diagnostic marker of AI 〉 8, the AUCs of Thl7/Treg and IL-17 were 0.87（0.76-0.99） and 0.84 （0.69

关 键 词：红斑狼疮 系统性 狼疮肾炎 T淋巴细胞 调节性 白细胞介素17 

分 类 号：R593.242[医药卫生—内科学]