【摘要】 目的 初步探讨复发缓解型多发性硬化(RRMS)缓解期肾虚湿热证患者的血清学特征。方法 回顾性选取RRMS缓解期患者27例作为RRMS组，以同期招募的26例健康志愿者作为健康组，并将RRMS组患者辨证分为肾虚湿热证和肾虚非湿热证两个亚组。采集所有受试者临床信息，采用扩展残疾量表(EDSS)评估患者神经功能损伤情况，利用单分子阵列分析技术检测受试者血清神经丝轻链蛋白(NfL)、可溶型程序性死亡受体1 (sPD-1)、可溶型程序性死亡配体1 (sPD-L1)水平，并采用Spearman法对RRMS患者血清NfL、sPD-1、sPD-L1水平之间的相关性及其与病程、发作次数、EDSS评分的相关性进行分析。结果RRMS组患者血清NfL、sPD-1、sPD-L1水平显著高于健康组(P<0.05或P<0.01)；肾虚湿热证亚组患者血清NfL、sPD-1、sPD-L1水平均高于肾虚非湿热证亚组患者(P<0.05或P<0.01)。RRMS组患者血清NfL水平与sPD-1、sPD-L1水平均呈正相关(P<0.01),sPD-1水平与sPD-L1水平呈正相关(P<0.001);RRMS组患者血清sPD-1水平与发作次数呈正相关(P=0.030)。结论 RRMS缓解期患者血清NfL、sPD-1、sPD-L1显著升高，且肾虚湿热证患者较肾虚非湿热证患者升高程度更为明显，提示RRMS肾虚湿热证患者可能存在更为严重的免疫炎症和神经损伤。更多还原

【Abstract】 Objective To preliminarily investigate the serological characteristics of relapsing-remitting multiple sclerosis(RRMS) patients with kidney deficiency and damp-heat syndrome during the remission period.Methods Twenty-seven patients with RRMS during the remission period were retrospectively included as the RRMS group,while 26 healthy volunteers of the same time period were recruited as the healthy group.The patients in the RRMS group were further divided into two subgroups according to whether there was damp-heat or not.The clinical data of all subjects was collected,and the expanded disability status scale(EDSS) was used to evaluate the neurological impairment.Single molecule array(Simoa) technology was used to detect the serum levels of neurofilament light chain(NfL),soluble programmed cell death protein 1(sPD-1),and soluble programmed death-ligand 1(sPD-L1).Spearman method was taken to analyze the correlation between serum NfL,sPD-1,and sPD-L1 levels in RRMS patients,and their correlations with course of disease,attack times,and EDSS score.Results The serum levels of NfL,sPD-1and sPD-L1 were significantly higher in the RRMS group than in the healthy group(P<0.05 or P<0.01),and were higher in the kidney deficiency and damp-heat subgroup than in the non-damp-heat syndrome subgroup(P<0.05 or P<0.01).In patients with RRMS,serum NfL level was positively correlated to sPD-1 and sPD-L1 levels(P<0.01),and sPD-1 level was positively correlated to sPD-L1 level(P<0.001);serum sPD-1 level was positively correlated to attack times(P = 0.030).Conclusion Serum levels of NfL,sPD-1,and sPD-L1 in patients with RRMS significantly increase during the remission period,and more changes are found if there is kidney deficiency and dampheat syndrome than non-damp-heat syndrome,suggesting that RRMS patients with kidney deficiency and damp-heat syndrome may be related to more serious immune inflammation and nerve damage.更多还原