系统性红斑狼疮患者外周血接触系统激活与血栓事件发生的关系  

Correlation of contact system activation with occurrence of thrombotic events in patients with systemic lupus erythematosus

作　　者：刘秀婵[1] 王植[2] 白人骁[1] 

机构地区：[1]天津市天津医院感染免疫风湿科,300211 [2]天津市天津医院放射科,300211

出　　处：《中华危重病急救医学》2016年第9期834-838,共5页Chinese Critical Care Medicine

基　　金：天津市医药卫生科技基金（2011KY26）

摘　　要：目的探讨外周血接触系统的激活在系统性红斑狼疮（SLE）患者血栓事件发生机制中的作用。方法采用随机抽样方法，入选2014年6月至2016年2月天津医院风湿科收治的69例SLE患者，根据是否合并心血管疾病（VD）将患者分为单纯SLE组（38例）和SLE＋VD组（31例），后者再根据合并VD的种类分为SLE合并心肌梗死（sLE＋MI，10例）、SLE合并深静脉血栓（SLE＋DVT，13例）、SLE合并动脉血栓（SLE＋AT，8例）3个亚组；同期选取68例年龄、性别相匹配的健康体检志愿者作为健康对照组。采用酶联免疫吸附试验（ELISA）检测各组血浆Ⅻ因子-C抑制剂复合物（FⅫa-CIINH）和Ⅻ因子抗凝血酶复合物（FⅫa-AT）水平，流式细胞仪分析SLE患者血小板相关因子的含量；Spearman相关分析FⅫIa-CIINH和FⅫa-AT与血小板相关因子的相关性。绘制受试者工作特征曲线（ROC），分析FⅫa-cIINH和FⅫIa-AT对SLE血栓事件发生的预测价值。结果与健康对照组比较，SLE组血浆FⅫa-CIINH水平显著下降[nmol／L：0．00（0．00，0．07）比0．08（0．03，0．13），P〈0．01]，FⅫa-AT水平显著升高[mnol／L：0．18（O．07，0．38）比0．16（0．12，0．26），P〈0．05]。与单纯SLE组相比，SLE＋DVT组和SLE＋AT组FⅫa-cIINH水平显著下降[nrnol／L：0．03（0．02，0．07）、0．02（0．01，0．04）比0．07（0．02，0．11），均P〈0．05]，SLE＋AT组血浆FⅫa-AT水平显著升高[nmol／L：0．34（0．21，0．52）比0．17（0．06，0．30），P〈0．01]。相关分析显示，SLE患者FⅫa-C11NH与FⅫa-AT呈显著负相关（r=-0．24，P=0．0416）；干扰素介导跨膜蛋白1（IFITMl）、干扰素诱导双链RNA依赖性激活剂（PRKRA）的产生与FⅫa-AT上调和FⅫa-cIINH下降均有相关性（IFITM1与FⅫa-AT：r=0．39、P=O．0012，IFITMl与FⅫa-c1INH：r=-0．30、P=0．0146，PRKRA与FⅫa-AT：r=0．29、P=O．0176，PRKRA与FⅫa-Objective To explore the role of contact system activation in the mechanism of systemic lupus erythematosus （SLE） patients with thrombotic events. Methods A simple sample drawing study was conducted. Sixty-nine patients with SLE admitted to Department of Rheumatism in Tianjin Hospital from June 2014 to Februay 2016 were enrolled. The patients were divided into simple SLE group （n = 38） and SLE ＋ vascular diseases （VD） group （n = 31） according to whether the patients complicated with VD or not. The VD patients were subdivided into three subgroups including SLE complicated with myocardial infarction （SLE ＋ MI, n = 10）, SLE complicated with deep vein thrombosis （SLE ＋ DVT, n = 13）, and SLE complicated with arterial thrombosis （SLE ＋ AT, n = 8）. Sixty-eight healthy age and gender-matched volunteers without history of VD were served as controls. Enzyme-linked immunosorbent assay （ELISA） was used to detect the content of FⅫa-C1 inhibitor （FⅫa-CIINH） and FⅫa-antithrombin （FⅫa-AT） in plasma. Flow cytometry was used to analyze the contents of platelets associated factors. The correlation between platelet associated factor and FⅫA-CIINH and FX]/a-AT was analyzed by Spearman correlation analysis. Receiver operating characteristic curve （ROC） was plotted to analyze the predictive value of FXUA-CIINH and FⅫa-AT for SLE thrombotic events. Results Compared with health control group, the expression of FⅫa-CIINH in plasma in SLE group was significantly decreased [nmol/L： 0.00 （0.00, 0.07） vs. 0.08 （0.03, 0.13）, P 〈 0.01], the expression of FⅫa-AT was significantly up-regulated [nmol/L： 0.18 （0.07, 0.38） vs. 0.16 （0.12, 0.26）, P 〈 0.05]. Compared with the simple SLE group, the expression of FⅫa-CIINH in SLE ＋ DVT and SLE ＋ AT groups was significantly decreased [nmol/L： 0.03 （0.02, 0.07）, 0.02 （0.01, 0.04） vs. 0.07 （0.02, 0.11）, both P 〈 0.05], and the expression of FⅫa-AT in plasma in SLE ＋ AT group was significant

关 键 词：系统性红斑狼疮 接触系统 血栓事件 

分 类 号：R593.241[医药卫生—内科学]