【摘要】 目的:分析系统性红斑狼疮(SLE)患者外周血中T淋巴细胞亚群的分布,并阐明其与SLE疾病活动性及预后的关系。方法:收集100例初治SLE患者外周血,分析不同临床亚型SLE患者(肾脏受累、皮肤受累、关节受累、血液系统受累和不同疾病活动期)T淋巴细胞亚群计数,评估初治SLE患者基线期临床指标与T淋巴细胞亚群计数之间的关系。100例患者中有78例随访12个月,随访患者中26例出现不良预后,比较预后不良组与临床缓解组SLE患者T淋巴细胞亚群计数;SLE患者T淋巴细胞亚群计数与临床指标的相关性分析采用Spearman相关分析。结果:狼疮肾炎组SLE患者CD3+T淋巴细胞、CD4+T淋巴细胞和CD8+T淋巴细胞计数低于非狼疮肾炎组(P<0.05),关节受累组SLE患者CD3+T淋巴细胞、CD4+T淋巴细胞计数低于非关节受累组(P<0.05),皮肤受累组SLE患者CD8+T淋巴细胞计数低于非皮肤受累组(P<0.05),血液系统受累组SLE患者CD3+T淋巴细胞、CD4+T淋巴细胞和CD8+T淋巴细胞计数低于非血液系统受累组(P<0.05)。SLE患者基线水平CD3+T淋巴细胞、CD4+T淋巴细胞和CD8+T淋巴细胞计数与SLE疾病活动性指标(SLEDAI)评分呈负相关关系(r=-0.391,P=0.001;r=-0.360,P=0.002;r=-0.315,P=0.008);CD3+T淋巴细胞、CD4+T淋巴细胞、CD8+T淋巴细胞计数与SLE患者血浆C3水平呈正相关关系(r=0.407,P=0.001;r=0.395,P=0.001;r=0.254,P=0.035);CD3+T淋巴细胞、CD4+T淋巴细胞和CD8+T淋巴细胞计数与SLE患者外周血淋巴细胞(LY)计数呈正相关关系(r=0.717,P=0.000;r=0.617,P=0.000;r=0.599,P=0.000);重度活动组SLE患者CD3+T淋巴细胞、CD4+T淋巴细胞和CD8+T淋巴细胞计数低于轻度活动组(P<0.05);预后不良组SLE患者CD3+T淋巴细胞和CD4+T淋巴细胞计数于临床缓解组(P<0.05)。结论:T淋巴细胞亚群分布在不同亚组SLE患者中各有不同,并且与SLE疾病活动性密切关联;CD4+T淋巴细胞计数与SLE患者预后不良有关,有可能成为SLE疾病活动性标志物和预后判断的标志物。更多还原

【Abstract】 Objective:To analyze the distribution of T lymphocyte subsets in peripheral blood of the systemic lupus erythematosus(SLE)patients,and to clarify its relationships with SLE disease activity and prognosis.Methods:The peripheral blood of 100 patients with primary SLE was collected,the counts of T lymphocyte subsets in the patients with different clinical subtypes of SLE(kidney involvement,skin involvement,joint involvement,hematological system involvement and different disease activity stages)were analyzed,and the relationships between the clinical indexes and the T lymphocyte subsets in the patients with primary SLE at baseline were evaluated.A total of 78 among 100 patients were followed up for 12 months,among them 26 patients had poor prognosis;the counts of T lymphocyte subsets in the patients with SLE were compared between poor prognosis group and clinical remission group.The correlations between the counts of T lymphocyte subsets in the SLE patients and the clinical indexes were analyzed by Spearman correlation test.Results:The counts of CD3+ T lymphocytes,CD4+T lymphocytes and CD8+ T lymphocytes of the SLE patients in lupus nephritis group were lower than those in nonlupus nephritis group(P<0.05),the counts of CD3+ T lymphocytes and CD4+ T lymphocytes in the SLE patients in joint involvement group were lower than those in non-joint involvement group(P<0.05),the count of CD8+ T lymphocytes of the SLE patients in skin involvement group was lower than that in non-skin involvement group(P<0.05),and the counts of CD3+ T lymphocytes,CD4+ T lymphocytes and CD8+ T lymphocytes of the SLE patients in hematological system involvement group were lower than those in non-hematological system involvement group(P <0.05).The counts of CD3+ T lymphocytes,CD4+ T lymphocytes,and CD8+T lymphocytes of the SLE patients were negatively correlated with the SLE disease activity index(SLEDAI)score(r=-0.391,P=0.001;r=-0.360,P=0.002;r=-0.315,P=0.008);the counts of CD3+ T lymphocytes,CD4+ T lymphocytes,and CD8+ T lymphocytes were positively correlated with the plasma C3 level of the SLE patients(r=0.407,P =0.001;r=0.395,P =0.001;r=0.254,P =0.035);the counts of CD3+T lymphocytes,CD4+ T lymphocytes,and CD8+ T lymphocytes were positively correlated with the lymphocyte(LY)level in peripheral blood of the SLE patients(r=0.717,P=0.000;r=0.617,P=0.000;r=0.599,P=0.000);the counts of CD3+ T lymphocytes,CD4+ T lymphocytes,and CD8+ T lymphocytes of the SLE patients in severe activity group were significantly lower than those in mild activity group(P<0.05);the counts of CD3+ T lymphocytes and CD4+ T lymphocytes of the SLE patients in poor prognosis group were lower than those in clinical remission group(P<0.05).Conclusion:The distribution of T lymphocyte subsets of the SLE patients in different subgroups is different,and it is closely associated with the SLE disease activity;the low count of CD4+T lymphocytes is associated with the poor prognosis of SLE patients,which may be a marker of SLE disease activity and prognostic judgment.更多还原