抗磷脂综合征患者血浆中补体激活片段的水平及临床意义  

The level and significance of plasma complement activation products in patients with anti-phospho-lipid syndrome

作　　者：王青松[1] 周滢波 方璇[1] 李向培[1] 汪国生[1] 钱龙[1] 陈玲[2] 吴竞生 厉小梅[1] 

机构地区：[1] 安徽医科大学附属省立医院风湿免疫科,合肥230001 [2] 安徽医科大学附属省立医院妇产科,合肥230001 [3] 安徽医科大学附属省立医院血液科,合肥230001

出　　处：《中华风湿病学杂志》2015年第5期292-296,共5页Chinese Journal of Rheumatology

基　　金：国家自然科学基金（81373187）;安徽省自然科学基金（1308085MH162）;中华医学会临床医学科研专项资金（12040730373）

摘　　要：目的 检测APS患者血浆中补体激活片段C4d、C5b-9,炎性细胞因子TNF-α、IFN-γ、IL-1β、IL-6、血管内皮生长因子（VEGF）的浓度水平,探讨其临床意义.方法 选取符合2006年悉尼国际APS会议修订的分类标准的APS患者60例（原发性APS 37例、继发性APS 23例）,另选健康成年人20名、健康孕妇10名作为健康对照组,利用ELISA法检测APS组及对照组血浆中的C4d、C5b-9,以及炎性细胞因子TNF-α、IFN-γ 、IL-1β、IL-6 、VEGF的水平,分析其在血浆中的变化及与实验室指标之间的相关性.2组间比较符合正态分布的计量资料用独立样本t检验,不符合正态分布的计量资料用秩和检验,变量间相关性分析采用Pearson相关或Spearman相关分析.结果 ①APS患者血浆中补体C5b-9浓度显著高于健康对照组[2 766.59（480.41,12 993.05） μg/ml与712.24 （340.96,2 770.26） μg/ml,Z=-6.347,P＜0.01],C4d浓度高于健康对照组[5.51（0.12,20.78） μg/ml与1.83（0.44,8.40） μg/ml,Z=-4.58,P＜0.01];APS患者血浆中炎性细胞因子TNF-α、IFN-γ、IL-1β水平高于健康对照组[27,86（1.54,488.53） pg/ml与24.15（1.51,54.38） pg/ml,Z=1.542,P＜0.05;4.36（1.12,41.98） pg/ml与1.53 （0.94,2.89） pg/ml,Z=1.505,P＜0.05;5.42（1.08,19.06） pg/ml与2.16 （0.26,5.26） pg/ml,Z=1.793,P＜0.05];IL-6 、VEGF水平低于健康对照组[1.93（1.39,5.42） pg/ml与2.97（1.41,7.26） pg/ml,Z=2.177,P＜0.01;66.58（5.13,177.38） pg/ml与108.34（50.95,290.55） pg/ml,Z=1.406,P＜0.05].②APS患者血浆中补体C5b-9浓度与ESR、抗心磷脂抗体（ACA） IgG、抗β2糖蛋白Ⅰ（β2-GP Ⅰ）抗体之间呈正相关（r=0.602,P＜0.01;r=0.287,P＜0.05;r=0.386,P＜0.01）,与补体C3、C4无相关性（r=-0.004,P＞0.05;r=-0.043,P＞0.05）;APS患者血浆中补体C4d浓度与补体C3、C4之间呈负相关（r=-0.951,P＜0.01;r=-0.803,P＜0.01）,与ACA IgG、ESR无相关性（P＞0.05）.结论 补体系统在APS中被激活,血浆中产生的补体裂解片段C4Objective To investigate the levels of plasma complement activation products C4d,C5b-9 and inflammatory cytokines tumor necrosis factor （TNF）-α,interferon （IFN）-γ,inteleukin （IL）-1β,IL-6,vascular endothelial growth factor （VEGF） in patients with antiphospholipid syndrome （APS）.Methods The expression levels of plasma C4d,C5b-9,TNF-α,IFN-γ,IL-1β,IL-6,VEGF in 60 APS patients and 30 healthy controls were analyzed by enzyme linked immunosorbent assay （ELISA）.The relationship between the C4d,C5b-9,TNF-α,IFN-γ,IL-1β,IL-6,VEGF and clinical data was analyzed in APS patients.Independent sample t test was used to compare the difference between the two groups if the data was in a normal distribution pattern and those data that were not accordance with normal distribution were analyzed by Mann-Whitney Utest.Pearson correlation analysis or Spearman correlation analysis were used for variables related analysis.Results ① Significant differences were found in the plasma levels of C5b-9,C4d,TNF-α,IFN-γ,IL-1β,IL-6,VEGF between APS patients and healthy controls.C5b-9,C4d were significantly higher in APS patients than those in the controls[2 766.59（480.41,12 993.05） μg/ml and 712.24（340.96,2 770.26） μg/ml,Z=-6.347,P〈0.01;5.51 （0.12,20.78） μg/ml and 1.83 （0.44,8.40） μg/ml,Z=-4.58,P〈0.01].TNF-α、IFN-γ、IL-1 β were significantly higher in APS patients than those in the controls as well [27,86 （1.54,488.53） pg/ml and 24.15 （1.51,54.38） pg/ml,Z=1.542,P〈0.05;4.36 （1.12,41.98） pg/ml and 1.53 （0.94,2.89） pg/ml,Z=1.505,P〈0.05;5.42 （1.08,19.06） pg/ml and 2.16 （0.26,5.26） pg/ml,Z=1.793,P〈0.05].The levels of IL-6 and VEGF were significantly lower in patients than those in the controls [1.93（1.39,5.42） pg/ml and 2.97（1.41,7.26） pg/ml,Z=2.177,P〈0.01;66.58 （5.13,177.38） pg/ml and 108.34 （50.95,290.55） pg/ml,Z=1.406,P〈0.05].② Significant positive correlation was observed between C5b-9 and ESR,anticardiolipin antibody （ACA） immun

关 键 词：抗磷脂综合征 抗体 抗磷脂 细胞因子类 补体激活片段 

分 类 号：R593.2[医药卫生—内科学]