糖皮质激素治疗对系统性红斑狼疮患者外周单个核细胞TLR7和TLR9表达的影响及相关因素分析  

Analysis of influencing factors and effects of glucocorticoid therapy on expression of the Toll-like receptors 7 and 9 in peripheral blood mononuclear cells in patients with systemic lupus erythematosus

作　　者：许敏玲 陈桃 蔡琪 XU Minling;CHEN Tao;CAI Qi(Department of Rheumatology,Xiaolan Hospital,South Medical University,Zhongshan 528415,China)

机构地区：[1]南方医科大学附属小榄医院风湿免疫科

出　　处：《实用医学杂志》2019年第12期1961-1966,共6页The Journal of Practical Medicine

基　　金：中山市科技计划项目(编号:2015SYF0104)

摘　　要：目的探讨糖皮质激素治疗对系统性红斑狼疮(SLE)患者外周血单个核细胞(PBMC)中Toll样受体(TLR7、TLR9)转录水平的影响及其可能的影响因素。方法收集40例SLE患者(激素治疗组24例,初次诊断组16例)以及健康对照组(19例)的临床资料和外周血,分离PBMC,通过定量PCR法检测TLR7和TLR9基因的转录水平,通过统计学分析组间的差异和相关变量分析。结果激素治疗组和初次诊断组SLE患者PBMC的TLR7和TLR9基因转录水平均高于健康对照组,差异具有统计学意义(P <0.05)。初次诊断组TLR7表达高于激素治疗组(P <0.05),但TLR9的增高差异无统计学意义。TLR7和TLR9的转录水平均与SLE的活动指数成正相关关系。TLR7还与抗Sm抗体滴度正相关,而TLR9与年龄、抗dsDNA抗体滴度、补体C4以及糖皮质激素治疗日均剂量等因素相关。通过线性回归模型进一步筛选变量提示TLR7主要与SLE活动指数相关,而TLR9的可能相关变量依次为SLE活动指数、补体C4和糖皮质激素治疗剂量。结论 TLR7和TLR9基因转录增高与SLE的病情活动具有正相关关系。影响TLR9表达的主要因素还包括近期糖皮质激素治疗剂量和补体C4水平。Objective To investigate the effect of glucocorticoid therapy on the transcriptional level of Toll-like receptors(TLR7,TLR9)in peripheral blood mononuclear cells of patients with systemic lupus erythematosus(SLE)and its possible influencing factors. Methods 40 patients with SLE(24 under treatment and 16 newly diagnosed)and 19 healthy controls were recruited. Peripheral blood mononuclear cells(PBMCs)were isolated and the transcriptional expression of TLR7 and TLR9 were measured by quantitative PCR. Their expression levels were statistically analyzed with clinical data to achieve candidate relative factors. Results The TLR7 and TLR9 transcriptional levels of PBMCs in the glucocorticoid-treated group and the newly diagnosed group were significantly higher than those in the healthy control(P < 0.05). The expression of TLR7 but not TLR9 were significantly lower in the treated group than the newly diagnosed group(P < 0.05). The transcriptional levels of TLR7 and TLR9 were positively correlated with SLE disease activity index(SLEDAI). TLR7 was also positively correlated with antiSmith antibody titer. TLR9 was associated with age,anti-dsDNA antibody titer,complement C4,and glucocorticoid dose. In the multivariate model,TLR7 was associated with SLEDAI,while TLR9 was associated with SLEDAI,complement C4 and glucocorticoid dose. Conclusions The expression of TLR7 and TLR9 is positively correlated with disease activity in SLE. Other related factors including glucocorticoid dose and complement C4 levels are involved in the TLR9 expression.

关 键 词：系统性红斑狼疮 外周血单个核细胞 TOLL样受体 糖皮质激素 病例对照研究 

分 类 号：R593.241[医药卫生—内科学]