SLE患者血清CXCL13水平与肾脏受累的相关性研究  

Serum CXCL13 and renal involvement in lupusc nephritis

作　　者：何德宁 胡建康[1] 朱静茹[1] 戴森华[1] 柳毓文 胡娜[1] HE Dening;HU jiangkang;ZHU jingru(Department of rheumatology,Pinxiang People＇s Hospital,Jiangxi Pinxiang,337000,China)

机构地区：[1]江西省萍乡市人民医院风湿免疫科,萍乡337000

出　　处：《江西医药》2018年第8期822-824,833,共4页Jiangxi Medical Journal

基　　金：江西省萍乡市科技计划项目;编号2015N004

摘　　要：目的了解狼疮肾炎(LN)患者血清趋化因子CXCL13表达变化,并观察其与肾脏受损、B细胞浸润的关系。方法采用ELISA方法检测不同受试者血清CXCL13水平。采用免疫组化法观察LN患者穿刺肾组织CD3、CD20、CD21表达并分析其与CXCL13关系。随访10例初诊LN患者并观察治疗6个月后血清CXCL13变化。结果血清CXCL13在LN组中表达明显高于无肾脏受累SLE组、健康对照组(χ~2=30.169,P<0.001)。SLE患者血清CXCL13水平与SLEDAI呈正相关(r=0.55,P<0.001),与补体C3呈负相关(r=-0.39,P<0.001)。Ⅲ型和Ⅳ型LN患者血清CXCL13水平均较V型LN患者升高(P均<0.05)。通过对肾组织研究发现,CD20+LN患者血清CXCL13水平高于CD20-LN患者(Z=2.844,P=0.004);2类LN患者(CD20+细胞及CD3+细胞均有表达且两者呈区域分布)血清CXCL13水平较0类LN患者(CD20+细胞无表达,和/或CD3+细胞表达)和1类LN患者(CD20+细胞表达,和/或CD3+细胞表达,两者呈散在分布)均明显升高(P均<0.05)。初诊LN患者接受激素、免疫抑制剂治疗6个月后血清CXCL13水平、SLEDAI评分均降低。结论 CXCL13在SLE发病过程中发挥重要作用,可能参与肾脏受累过程,引起B细胞在肾组织中异常聚集、形成异位淋巴样组织。Objective To determine serum levels of chemokine CXCL13 in patients with lupus nephritis,and analyse its correlations with renal involvement and B-cell infiltrates. Methods CXCL13 was measured in sera obtained from 89 patients with LN,25 patients with SLE and 11 healthy controls by ELISA methodology. The renal specimen were analyzed by light microscopy examination of routine pathology and immunohistochemistry detection of CD3,CD20 and CD21 expression. Clinical data including SLEDAI,complement C3 and anti-dsDNA level were collected and evaluated. Results Median （IQR） serum CXCL13 concentrations were increasingly higher across the following groups：healthy controls,SLE patients and LN patients. Concentrations of CXCL13 correlated with SLEDAI and complement C3 levels. CXCL13 levels of Ⅲ and Ⅳ LN patients were higher than those in Ⅴ LN patients. Based on whether or not there was CD20＋ cells in renal tissue,the concentrations of CXCL13 were higher in CD20＋LN patients compared to CD20-LN patients （P=0.004）. With respect to B lymphocytes associated ELT formation,there were higher CXCL13 concentrations in type 2 patients presented as areal distribution of CD3＋T cells and CD20＋B cells （type 2） but no expression of CD21＋ dendritic cells expression than in type 1 or type 0 patients. Moreover,after glucocorticoid and immunosuppressire drugs treatment the levels of CXCL13 and SLEDAI of LN patients were reduced （P〈0.05）. Conclusion Our results implied that CXCL13 played an important role in the pathogenesis of SLE and involved in renal injure,causing B-cell infiltrates and formation of ectopic lymphoid tissue. CXCL13 might be an useful marker of SLE and renal involvement.

关 键 词：狼疮肾炎 炎症趋化因子(CXCL13) B淋巴细胞 异位淋巴样组织 

分 类 号：R593.242[医药卫生—内科学]