糖皮激素对狼疮性肾炎患者活动性作用与肾内B淋巴细胞刺激因子的相关性

摘要

目的 探讨糖皮质激素(GC)对狼疮性肾炎(LN)患者活动性作用与肾内B淋巴细胞刺激因子(BlyS)的相关性分析.方法 选取LN患者共35例LN组,9例健康体检者为血清健康对照组,10例肾肿瘤切除患者为正常肾脏对照组.按照GC治疗时间分为未治疗组共17例和治疗＞4周组共18例.采用免疫组化法及酶联免疫吸附试验(ELISA)法检测LN患者与健康体检者血清内及正常肾组织内的BlyS表达水平.对比观察未治疗组与治疗＞4周组LN患者的血清BlyS、抗ds-DNA水平,ANA滴度、狼疮活动指数(SLE-DAI)和肾内BlyS值.结果 LN患者血清的BlyS水平为(118.26±0.76) ng/ml,明显高于正常血清健康对照组血清的BlyS水平(95.26±1.09) ng/ml,差异具有显著性(P＜0.05);35例LN患者肾内BlyS水平为(6.72±0.45) ng/ml显著高于正常对照组肾内的BlyS水平(4.72±0.97)ng/ml,差异具有显著性(P ＜0.05);GC治疗＞4周组的LN患者肾内BlyS水平及SLE-DAI评分低于未经过GC治疗的LN患者,差异具有显著性(P＜0.05),而两组血清BlyS、抗ds-DNA水平及ANA滴度无显著差异(P＞0.05).结论 GC减轻LN患者疾病活动性的作用可能与GC降低LN患者肾内BlyS表达水平有密切关系.%Objective To discuss the effect of glucocorticoid on patients with lupus nephritis and its conrelation with B lymphocyte stimulator.Methods A total of 35 LN patients were enrolled in this study.Nine healthy subjects were serum healthy control group and 10 patients with renal tumor resection were renal healthy control group.According to GC treatment time,there were 17 cases in untreated group and 18 cases in treatment group ＞4 weeks.Immunohistochemical and ELISA were used to detect serum and expression levels of BlySin the normal kidney tissue.The levels of serum BlyS,anti-dsDNA,ANA titer,lupus activity index (SLE-DAI) and intrarenal BlyS values in the untreated group and those in the treatment ＞ 4 weeks group were compared.Results The level of BlyS in serum of patients with LN was (118.26 ±0.76) ng/ml,which was significantly higher than that of healthy controls (95.26 ± 1.09) ng/ml (P ＜ 0.05).The level of BlyS in kidney of patients with LN was (6.72 +0.45) ng/ml,which was significantly higher than that in the control group (4.72 ±0.97) ng/ml (P ＜0.05).The level of BlyS and SLE-DAI scores in the GC treatment ＞ 4 week group LN patients were lower than those of patients without LN with statistical significant difference (P ＜ 0.05).There was no significant difference in serum BlyS,anti-dsDNA level and ANA titer between the two groups.Conclusion GC can reduce the disease activity in LN patients,it can be speculated that GC is closely related with the level of BlyS of LN patients.