系统性红斑狼疮患者外周血Th17/Treg细胞和尿单核细胞趋化蛋白-1的检测及意义  

Detection and significance of peripheral blood Th17/Treg cells and urinary monocyte chemoattractant protein-1 in patients with systemic lupus erythematosus

作　　者：郑雪娜 杨华强 李博君 覃骏 Zheng Xuena;Yang Huaqiang;Li Bojun;Qin Jun(Department of Hematology,Renmin Hospital,Hubei University of Medicine,Hubei Province,Shiyan 442000,China)

机构地区：[1]湖北医药学院附属人民医院/十堰市人民医院血液科,湖北十堰442000

出　　处：《疑难病杂志》2023年第4期420-425,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：湖北省教育厅科学研究重点计划(D20142104)。

摘　　要：目的检测系统性红斑狼疮(SLE)患者外周血辅助性T细胞17(Th17细胞)/调节性T细胞(Treg细胞)比率及尿液单核细胞趋化蛋白-1(MCP-1)水平及临床意义。方法选取2018年7月—2020年9月十堰市人民医院收治SLE患者68例,根据SLE患者有无肾脏受累分为非狼疮肾炎组28例(non-LN组)和狼疮肾炎组40例(LN组),同期医院健康体检者35例为健康对照组。收集受试者临床资料,采用流式细胞术检测外周血单个核细胞(PBMC)中Th17细胞和Treg细胞比率,采用RT-PCR技术检测Th17细胞和Treg细胞相应的转录因子维甲酸相关孤核受体(ROR-γt)和叉头螺旋翼状转录因子3(Foxp3)mRNA表达量,采用ELISA法检测尿液MCP-1水平。采用Spearman相关分析Th17/Treg细胞比率与尿液MCP-1的关系及其与临床指标的相关性,采用受试者工作特征曲线(ROC)分析Th17/Treg细胞比率和尿液MCP-1水平诊断SLE患者合并LN效能。结果LN组和non-LN组Th17细胞比例均高于健康对照组(F=12.345,P=0.015),Treg细胞比例比较,LN组<non-LN组<健康对照组(F=22.388,P<0.001),Th17/Treg细胞比率比较,LN组>non-LN组>健康对照组(F=26.674,P<0.001);ROR-γt mRNA表达水平比较,LN组>non-LN组>健康对照组(F=20.578,P<0.001),LN组和non-LN组Foxp3 mRNA表达水平均低于健康对照组(F=7.782,P=0.003);尿液MCP-1水平比较,LN组>non-LN组>健康对照组(F=51.231,P<0.001)。Spearman相关分析显示,SLE患者Th17/Treg细胞比率与尿液MCP-1水平呈正相关(r=0.604,P=0.017),SLE患者Th17/Treg细胞比率与SLEDAI评分呈正相关(r=0.534,P=0.021),尿液MCP-1水平与SLEDAI评分和24 h尿蛋白定量呈正相关(r/P=0.342/<0.001,0.412/0.023)。ROC曲线显示,Th17/Treg细胞比率、尿液MCP-1预测SLE患者合并LN的曲线下面积(AUC)为0.718、0.769,敏感度为0.782、0.993,特异度为0.736、0.569。结论SLE合并LN患者体内存在Th17/Treg细胞比例失衡及尿液MCP-1水平的增加,二者联合检测可作为判断SLE患者疾病活动的指标,有助于评�Objective To investigate the ratio of peripheral blood helper T cells 17(Th17 cells)to regulatory T cells(Treg cells)and the level of urinary monocyte chemoattractant protein-1(MCP-1)in patients with systemic lupus erythematosus(SLE).Methods A total of 68 patients with SLE admitted to Shiyan People's Hospital from July 2018 to September 2020 were selected and divided into a non lupus nephritis group of 28 patients(non-LN group)and a lupus nephritis group of 40 patients(LN group)based on whether or not the SLE patients had renal involvement.During the same period,35 healthy physical examinees from the hospital were included in the healthy control group.Collect clinical data of subjects,use flow cytometry to detect the ratio of Th17 cells to Treg cells in peripheral blood mononuclear cells(PBMC),and use RT-PCR technology to detect the corresponding transcription factor retinoic acid related solitary nuclear receptor(ROR-γt)of Th17 cells and Treg cells),and the expression of forked helical wing like transcription factor 3(Foxp3)mRNA.Urine MCP-1 levels were measured using ELISA.Spearman correlation was used to analyze the relationship between Th17/Treg cell ratio and urine MCP-1,as well as its correlation with clinical indicators.Subjects'performance characteristic curve(ROC)was used to analyze Th17/Treg cell ratio and urine MCP-1 levels in the diagnosis of LN in patients with SLE.Results The ratio of Th17 cells in LN group and non LN group was higher than that in healthy control group(F=12.345,P=0.015).The ratio of Treg cells in LN group<non-LN group<healthy control group(F=22.388,P<0.001),and the ratio of Th17/Treg cells in LN group>non-LN group>healthy control group(F=26.674,P<0.001);Comparison of ROR-γt mRNA expression levels in LN group>non-LN group>healthy control group(F=20.578,P<0.001).The expression level of Foxp3 mRNA in LN group and non-LN group was lower than that in healthy control group(F=7.782,P=0.003);Comparison of urinary MCP-1 levels in LN group>non-LN group>healthy control group(F=51.231,P<0.001)

关 键 词：系统性红斑狼疮 狼疮肾炎 辅助性T细胞17 调节性T细胞 单核细胞趋化蛋白-1 

分 类 号：R593.241[医药卫生—内科学]