晚发系统性红斑狼疮患者外周血CD4^(+)T细胞亚群水平变化及临床意义  

Changes of the level and clinical significance of peripheral blood CD4^(+)T cell subpopulations in lateonset systemic lupuserythematosus

作　　者：薛丽巾[1] 郝莉敏[1] 赵文鹏[1] 赵向聪[1] 罗静[1] 王彩虹[1] 牛红青[1] Xue Lijin;Hao Limin;Zhao Wenpeng;Zhao Xiangcong;Luo Jing;Wang Caihong;Niu Hongqing(Department of Rheumatology and Immunology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院风湿免疫科,太原030001

出　　处：《中华风湿病学杂志》2023年第9期604-610,共7页Chinese Journal of Rheumatology

基　　金：山西省自然科学研究面上项目(20210302123274);山西医科大学第二医院2020年度院科研基金(202001-3)。

摘　　要：目的探讨晚发SLE患者外周血CD4^(+)T细胞亚群水平及其临床意义。方法收集2016年1月至2021年12月就诊于山西医科大学第二医院风湿免疫科的260例初诊SLE患者临床资料, 其中晚发SLE(发病年龄≥50岁)58例, 普通SLE(18岁≤发病年龄≤49岁)202例。并收集同期健康体检者160名为健康对照, 其中年龄50~85岁者35名为健康对照1组, 年龄18~49岁者125名为健康对照2组。采集所有患者和健康对照者外周血, 流式细胞术检测外周血CD4^(+)T细胞亚群。采用SPSS 22.0统计软件进行χ^(2)检验或Mann-WhitneyU检验比较组间差异。结果 (1)与普通SLE患者相比, 晚发SLE患者确诊所需时间延长[5.0(2.0, 24.0)个月和3.0(1.0, 7.3)个月, Z=-3.13, P=0.002], 疾病活动度SLEDAI评分降低[12.0(8.0, 15.2)分和14.0(10.0, 18.0)分, Z=-2.12, P=0.034]。晚发SLE患者更易出现体质量减轻、恶心、腹痛, 更易并发脑梗死、间质性肺炎、干燥综合征和感染, 而皮肤黏膜受累相对少见。(2)CD4+T细胞亚群:①与健康对照1组相比, 晚发SLE患者外周血调节性T细胞(Treg)、Th17、Th1、Th2细胞绝对计数均明显降低[Treg:10.94(6.14, 19.23)个/μl和32.65(28.07, 41.65)个/μl, Z=-6.79, P<0.001;Th17:3.43(0.94, 5.64)个/μl和6.13(3.77, 7.82)个/μl, Z=-3.24, P=0.001;Th1:36.02(10.80, 76.38)个/μl和128.70(89.82, 159.89)个/μl, Z=-5.29, P<0.001;Th2:3.56(1.56, 6.06)个/μl和8.25(4.69, 12.98)个/μl, Z=-4.57, P<0.001], 而Th17/Treg细胞比值明显升高[0.28(0.13, 0.59)和0.17(0.12, 0.28), Z=-2.38, P=0.017]。②与健康对照2组相比, 普通SLE患者外周血Treg、Th17、Th1、Th2细胞绝对计数均明显降低[Treg:10.28(5.37, 17.04)个/μl和30.19(21.20, 39.75)个/μl, Z=-11.28, P<0.001;Th17:3.44(1.84, 6.14)个/μl和6.48(4.23, 10.66)个/μl, Z=-6.53, P<0.001;Th1:29.59(15.14, 56.81)个/μl和90.75(42.67, 162.00)个/μl, Z=-7.01, P<0.001;Th2:2.74(1.62, 4.77)个/μl和8.25(4.75, 11.99)个/μl, Z=-9.91, P<0.001], 而Th17/Treg细胞比值明显升高[0.Objective To investigate the level and clinical significance of peripheral blood CD4^(+)T cell subpopulations in late-onset systemic lupus erythematosus(SLE)patients.Methods This study included 260 SLE patients hospitalized in the Rheumatology and Immunology Department of the Second Hospital of Shanxi Medical University from January 2016 to December 2021:of whom 58 and 202 were late-(≥50 years)and adult-(18~49 years)onset patients.This study also included 160 subjeces as healthy controls(HCs),of whom 35 and 125 were Control Group 1(≥50 years)and Control Group 2(18~49 years).Peripheral blood CD4^(+)T lymphocyte subsets of these participants were assessed by flow cytometry.The clinical data of all patients and healthy controls(HCs)were recorded.The differences between the groups were analyzed by Mann-Whitney U test or χ^(2) test.Results(1)The time of diagnosis of late-onset SLE was longer than that of adult-onset SLE[Median time:5.0(2.0,24.0)months vs 3.0(1.0,7.3)months,Z=-3.13,P=0.002].Compared with adult-onset SLE,the SLEDAI score of late-onset SLE was lower[12.0(8.0,15.2)vs 14.0(10.0,18.0),Z=-2.12,P=0.034].Some manifestations occurred more frequently in late-onset SLE,such as weight loss,nausea,abdominal pain,cerebral infarction,interstitial pneumonitis,Sjogren's syndrome and infection.The manifestations of skin and mucos a occurred less frequently in late-onset SLE.(2)CD4^(+)T cell subpopulations:The absolute counts of Treg,Th17,Thl and Th2 cells in the peripheral blood of patients with late-onset SLE were significantly lower than those of HCs[Treg:10.94(6.14,19.23)vs 32.65(28.07,41.65),Z=-6.79,P<0.001;Th17:3.43(0.94,5.64)vs 6.13(3.77,7.82),Z=-3.24,P=0.001;Th1:36.02(10.80,76.38)vs 128.70(89.82,159.89),Z=-5.29,P<0.001;Th2:3.56(1.56,6.06)vs 8.25(4.69,12.98),Z=-4.57,P<0.001].The ratio of Th17/Treg cells was higher than that of HCs[0.28(0.13,0.59)vs 0.17(0.12,0.28),Z=-2.38,P=0.017].②The absolute counts of Treg,Th17,Th1 and Th2 cells in peripheral blood of patients with adult-onset SLE were significantly lowe

关 键 词：红斑狼疮 系统性 年龄特征 T淋巴细胞 调节性 

分 类 号：R593.241[医药卫生—内科学]