人循环T免疫指数及血小板参数对系统性红斑狼疮治疗效果的预测价值  

Predictive value of human circulating T immune index and platelet parameters on the therapeutic effect of systemic lupus erythematosus

作　　者：王静 杨肖飞 WANG Jing;YANG Xiaofei(Department of Clinical Laboratory,The Second Affiliated Hospital of Air Force Military Medical University,Xi'an 710038)

机构地区：[1]空军军医大学第二附属医院检验科,西安市710038

出　　处：《湖南师范大学学报(医学版)》2024年第5期128-133,共6页Journal of Hunan Normal University(Medical Sciences)

基　　金：陕西省卫生健康委员会科研项目“人循环T免疫指数及血小板参数对系统性红斑狼疮治疗效果的预测价值”(2022E023)

摘　　要：目的:分析来自活动期和非活动期系统性红斑狼疮(systemic lupus erythematosus,SLE)患者以及正常对照组的CD4^(+)CD28^(null)T细胞、血小板结合补体裂解产物(platelet bound complement split product,PC4d)水平变化,并评估它们作为疾病活动和治疗效果判断的生物标志物的意义。方法:这是一项在本院进行的单中心、观察性队列研究,研究时间为2021年1月—2022年6月,研究对象为15~70岁的90例SLE患者和22名健康对照。计算系统性红斑狼疮疾病活动指数(systemic lupus erythematosus disease activity index,SLEDAI),以评估整体疾病活动;SLEDAI评分>4分的患者视为活动期SLE,其余患者被归类为非活动期SLE。通过流式细胞术分析CD4^(+)CD28^(null)T细胞、PC4d水平。结果:与健康对照组相比,活动性SLE组患者更年轻,CD4^(+)CD28^(null)T、PC4d水平更高。活动性SLE组和非活动性SLE组患者的WHO分级、SLEDAI、CD4^(+)CD28^(null)T细胞的差异有统计学意义。CD4^(+)CD28^(null)T、PC4d水平与SLEDAI呈显著正相关性(r=0.214,P<0.05;r=0.410,P<0.05)。不同WHO分级的CD4^(+)CD28^(null)T细胞百分比的差异有统计学意义,其中WHO 5级的CD4^(+)CD28^(null)T细胞百分比显著高于其他分级。与有治疗反应组相比,无治疗反应组的CD4^(+)CD28^(null)T、PC4d水平显著增加。ROC曲线显示CD4^(+)CD28^(null)T、PC4d预测活动期SLE治疗反应的AUC值分别为0.759(95%CI:0.604~0.914)、0.923(95%CI:0.832~1.000)。结论:CD4^(+)CD28^(null)T细胞群扩增和PC4d水平升高与SLE患者的疾病活动度密切相关,并且二者可作为预测活动性SLE患者治疗反应的潜在候选生物标志物。Objective To analyze the changes of CD4^(+)CD28^(null)T cells and platelet-bound complement cleavage products(PC4d)in patients with active and inactive systemic lupus erythematosus(SLE)and normal controls,and evaluate their significance as biomarkers for judging disease activity and therapeutic effect.Methods This was a single-center,observational cohort study in our hospital.The study time is from January 2021 to June 2022.The subjects were 90 SLE patients aged 15-70 and 22 healthy controls.Calculate systemic lupus erythematosus disease activity index(SLEDAI)to evaluate the overall disease activity;Patients with SLEDAI score>4 were regarded as active SLE,and the rest were classified as inactive SLE.The levels of CD4^(+)CD28^(null)T cells and PC4d were analyzed by flow cytometry.Results Compared with the healthy control group,the patients in active SLE group were younger,and the levels of CD4^(+)CD28^(null)T and PC4d were higher.The differences in WHO classification,SLEDAI,and CD4^(+)CD28^(null)T cells between patients with active SLE and those with inactive SLE were statistically significant.The levels of CD4^(+)CD28^(null)T and PC4d were positively correlated with SLEDAI(r=0.214,P<0.05;r=0.410,P<0.05).The difference in the percentage of CD4^(+)CD28^(null)T cells across different WHO classifications was statistically significant.and the percentage of CD4^(+)CD28^(null)T cells in WHO grade 5 was significantly higher than that in other grades.Compared with the group with treatment response,the levels of CD4^(+)CD28^(null)T and PC4d in the group without treatment response increased significantly.ROC curve showed that the AUC values of CD4^(+)CD28^(null)T and PC4d in predicting the treatment re-sponse of SLE in active stage were 0.759(95%CI:0.604-0.914)and 0.923(95%CI:0.832-1.000),respectively.Conclusion The expansion of CD4^(+)CD28^(null)T cell and the increase of PC4d level are closely related to the disease activity of SLE patients,and they can be used as potential candidate biomarkers to predict the treatment re

关 键 词：系统性红斑狼疮 活动期 CD4^(+)CD28^(null)T细胞 血小板结合补体裂解产物 治疗反应 

分 类 号：R593[医药卫生—内科学]