【摘要】 目的:探讨白细胞介素1β(IL-1β)、IL-6、IL-8、γ干扰素(IFN-γ)在中枢神经系统神经精神狼疮(CNS-NPSLE)发病中的作用。方法:收集CNS-NPSLE、无CNS表现SLE(non-CNS SLE)、颅内感染患者及正常对照组的血清和脑脊液(CSF),应用酶联免疫吸附法测定血清及CSF中IL-1β、IL-6、IL-8、IFN-γ水平,对各组血清、CSF细胞因子水平进行比较。对患者及正常对照组均行颅脑MRI影像学检查。以CNS-NPSLE组各种细胞因子血清及CSF水平的2.5%下限为阳性界值,比较CNS-NPSLE不同颅脑MRI影像学病变的细胞因子阳性率差异,分析细胞因子与颅脑MRI表现的关系。结果:①CNS-NPSLE组、non-CNS SLE组、颅内感染组及正常对照组之间年龄、性别均无统计学差异(F=1.34,P>0.05;χ2=2.05,P>0.05)。②CNS-NPSLE组血清、CSF中IL-1β、IL-6、IL-8、IFN-γ水平均明显高于正常对照组(血清,Z14=6.22、6.04、6.22、5.70;CSF,Z14=6.38、7.10、6.97、6.34,P均<0.008 3);③CNS-NPSLE组CSF IL-1β、IL-6、IL-8水平均高于non-CNS SLE组(Z12=2.73、Z12=3.18、Z12=3.86,P均<0.008 3);④CNS-NPSLE组CSF IL-1β、IL-6、IL-8、IFN-γ水平均高于血清水平(Z=3.19、6.30、5.44、3.19,P均<0.05)。⑤CSF IL-6>20.067 9 pg/ml、IL-8>87.181 1 pg/ml,发生CNS-NPSLE的风险增加(χ2=11.98,P<0.05;χ2=4.65,P<0.05)。⑥CNS-NPSLE患者中,脱髓鞘病变CSF IL-1β、IL-6阳性率显著高于MRI正常者(χ2=10.89,P<0.005;χ2=18.47,P<0.005);多发性缺血灶CSF IL-6、IFN-γ阳性率显著高于MRI正常者(χ2=5.56,P<0.005;χ2=14.59,P<0.005)。结论:CNS-NPSLE患者的IL-1β、IL-6、IL-8、IFN-γ血清及CSF水平发生变化,可能与CNS-NPSLE的发病有一定的关系。更多还原

【Abstract】 Objective: To investigate the role of IL-1β,IL-6,IL-8 and IFN-γ to the pathogenesis of central nervous system neuropsychiatric systemic lupus erythematous( CNS-NPSLE). Methods: Patients with CNS-NPSLE,non-CNS SLE,encephalic infection and normal controls were enrolled in the study. The serum and cerebrospinal fluid( CSF) levels of IL-1β,IL-6,IL-8 and IFN-γwere measured by enzyme linked immunosorbent assay( ELISA). All patients and normal controls were detected by brain magnetic resonance imaging( MRI). With the 2. 5% reference value of each cytokine serum and CSF level in CNS-NPSLE patients as positive value,the relationship of cytokine to MRI characteristics were analyzed by logistic regression. Results: ① There were no significant difference among CNS-NPSLE,non-CNS SLE,encephalic infection,and normal control group in sex and age match( F = 1. 34,P >0. 05; χ2= 2. 05,P > 0. 05). ②The serum and CSF IL-1β,IL-6,IL-8 and IFN-γ levels of CNS-NPSLE were significantly higher than that of normal controls( serum,Z14= 6. 22,6. 04,6. 22,5. 70; CSF,Z14= 6. 38,7. 10,6. 97,6. 34,P < 0. 008 3). ③ The CSF IL-1β,IL-6 and IL-8 levels of CNS-NPSLE were significantly higher than that of non-CNS SLE( Z12= 2. 73,Z12= 3. 18,Z12= 3. 86,P < 0. 008 3). ④ The CSF IL-1β,IL-6,IL-8 and IFN-γ levels of CNS-NPSLE were all significantly higher than serum levels( Z =3. 19,6. 30,5. 44,3. 19,P < 0. 05). ⑤ The CNS-NPSLE onset risk would increase as the IL-6 and IL-8 CSF level above 20. 067 9pg / ml and 87. 1811 pg / ml respectively( χ2= 11. 98,P < 0. 05; χ2= 4. 65,P < 0. 05). ⑥The CNS-NPSLE with demyelination had significantly higher CSF IL-1β,IL-6 positive rates than that of CNS-NPSLE with normal MRI( χ2= 10. 89,P < 0. 005; χ2= 18. 47,P < 0. 005); The CNS-NPSLE with multiple focal ischemia had significantly higher CSF IL-6,IFN-γ positive rate than that of CNSNPSLE with normal MRI( χ2= 5. 56,P < 0. 005; χ2= 14. 59,P < 0. 005). Conclusion: Some cytokines are abnormally expressed in CNS-NPSLE and may be associated with CNS-NPSLE pathogenesis.更多还原