顽固性RAU免疫指标改变及沙利度胺治疗对其免疫水平的影响

发布时间：2018-03-09 08:26

  本文选题：顽固性RAU　切入点：免疫球蛋白　出处：《南京大学》2017年硕士论文　论文类型：学位论文

【摘要】：第一部分顽固性复发性阿弗他溃疡患者外周血免疫球蛋白及补体的改变[目的]观察RAU患者外周血免疫球蛋白及补体水平的改变,同时比较顽固性RAU和普通性RAU改变的差异,为探讨RAU发病机理提供实验依据。[方法]收集顽固性RAU患者329例,普通性RAU患者296例及健康对照组217例,采用免疫比浊法测定免疫球蛋白和补体(IgG、IgA、IgM、C3和C4),根据多点校准品浓度和对应吸光度变化值ΔA,采用非线性校准法log(4p)确定工作曲线,所测样本吸光度变化在工作曲线上相对应的浓度值即为所测浓度。IgE采用电化学发光法测定,检测结果由机器自动从标准曲线上获得。对结果采用SPSS 18.0统计软件进行检验,检验水准为双侧α = 0.05。[结果]RAU患者免疫球蛋白(IgG、IgA、IgM、IgE)及补体(C3、C4)水平升高;顽固性RAU和普通性RAU患者比较可示,IgG、IgA、IgE升高(P0.01),C3、C4升高(P0.05);与健康对照组比较,顽固性RAU IgG、IgA、IgE和C3、C4升高(P0.01)。而普通性RAU与健康对照组比较,免疫球蛋白水平未出现差异(P0.05),C3和C4升高(P分别为P0.01、P0.05)。[结论]RAU患者免疫球蛋白和补体水平升高,其中顽固性RAU患者免疫球蛋白水平升高更为明显。第二部分顽固性复发性阿弗他溃疡患者外周血淋巴细胞亚群比例的变化[目的]本研究对RAU患者淋巴细胞亚群比例进行综合分析,探讨顽固性RAU、普通性RAU及健康对照组淋巴细胞亚群比例并进行比较与分析,为深入探究RAU的发病机制提供实验依据。[方法]收集顽固性RAU患者329例,普通性RAU患者296例及健康对照组217例,淋巴细胞亚群(CD19+、CD3+、CD4+、CD8+、NK)比例采用流式细胞术检测,使用BD CellQuest Pro软件采集和分析列表模式数据。[结果]RAU患者淋巴细胞比例中CD4+和CD4+/CD8+下降,CD8+T和NK升高(P0.01)。顽固性RAU和普通性RAU比较,CD19+和CD4+/CD8+细胞比例下降,CD8+T细胞比例升高(P0.01);顽固性RAU与健康对照组比较,CD19+、CD4+T细胞比例和CD4+/CD8+比值下降,CD8+T细胞比例升高(P0.01),CD3+和NK细胞比例升高(P0.05)。普通性RAU与健康对照组比较,仅出现CD4+T细胞比例下降(P0.05)。[结论]RAU患者淋巴细胞亚群比例失衡,其中顽固性RAU患者细胞免疫改变幅度更加明显。第三部分沙利度胺治疗对顽固性复发性阿弗他溃疡免疫水平的影响[目的]观察沙利度胺治疗顽固性RAU的短期临床疗效,检测并分析沙利度胺治疗顽固性RAU患者前、后外周血免疫指标的改变,探讨沙利度胺治疗顽固性RAU患者免疫水平的影响,为研究沙利度胺治疗顽固性RAU的作用机制提供实验依据。[方法]选择顽固性RAU患者80例和健康对照组80例,对沙利度胺治疗顽固性RAU患者,观察其治疗1个月和停药2个月临床疗效,采用免疫比浊法、电化学发光法和流式细胞术对沙利度胺治疗顽固性RAU患者1个月后测定其外周血免疫球蛋白、补体水平及淋巴细胞亚群比例,并记录临床疗效,采用SPSS 18.0统计软件进行统计学分析。[结果]沙利度胺治疗顽固性RAU1个月和停药2个月后,间歇期延长,愈合时间缩短,溃疡发作时的数目减少,VAS疼痛评分降低(P0.05),但停药2个月与治疗1个月疗效相比有减弱趋势。治疗1个月后免疫球蛋白及补体中IgG、IgA、C3和C4水平降低(P0.05),淋巴细胞亚群中CD4+T细胞比例升高(P0.05)。[结论]沙利度胺治疗顽固性RAU的临床疗效明显,沙利度胺治疗对顽固性RAU患者的免疫水平产生了一定影响,调节体液和细胞免疫的作用可能是其治疗顽固性RAU的机制之一。
[Abstract]:The first part of intractable recurrent aphthous ulcer in patients with peripheral blood immunoglobulin and complement change [Objective] to observe RAU in peripheral blood of patients with immunoglobulin and complement level changes, and compare the differences of refractory RAU and ordinary RAU change, provide the experimental basis for the method. From 329 RAU patients with refractory in order to explore the pathogenesis of RAU, normal 296 cases RAU patients and healthy control group of 217 cases, the determination of immunoglobulin and complement the immune turbidimetric method (IgG, IgA, IgM, C3 and C4), a A value based on the multi-point calibration concentration and the corresponding absorbance change, using nonlinear calibration method log (4P) determine the working curve, concentration of samples corresponding to the absorbance change at work curve value is measured by the concentration of.IgE by electrochemical luminescence assay, the detection results by the machine automatically from the standard curve is obtained. The results using SPSS 18 statistical software. Test, the test level of bilateral alpha = 0.05.[results]RAU patients IgA (IgG, IgA, IgM, IgE) and complement (C3, C4) level increased; refractory RAU and ordinary RAU were compared in IgG, IgA, IgE increased (P0.01), C3, C4 increased (P0.05); compared with the healthy control group, IgG IgA, refractory RAU, IgE and C3, increased C4 (P0.01) and the control group. Compared with the ordinary RAU and health, immunoglobulin levels showed no difference (P0.05), C3 and C4 increased (P = P0.01, P0.05) increased. Conclusion immunoglobulin in patients with]RAU the level of protein and complement, immunoglobulin in patients with refractory RAU levels increased more significantly. The ratio of second parts of refractory patients with recurrent aphthous ulcer of peripheral blood lymphocyte subsets [Objective] this study conducted a comprehensive analysis of the proportion of lymphocyte subpopulation of patients with RAU, to investigate the refractory RAU, ordinary RAU and health the control group lymphocyte subsets ratio With comparison and analysis, to provide experimental basis for the method. From 329 RAU patients with intractable to delve into the pathogenesis of RAU, common in 296 cases of RAU patients and healthy control group of 217 cases, lymphocyte subsets (CD19+, CD3+, CD4+, CD8+, NK) ratio was detected by flow cytometry, the use of BD CellQuest Pro software acquisition and analysis of data. The list mode results of CD4+ and CD4+/CD8+ lymphocytes in patients with]RAU ratio decreased, CD8+T and NK increased (P0.01). Comparison of refractory RAU and common RAU, CD19+ and CD4+/CD8+ cells decreased the proportion of CD8+T cells than Li Shenggao (P0.01); refractory RAU compared with the healthy control group, CD19+ the proportion of CD4+T cells, and CD4+/CD8+ ratio decreased, the proportion of CD8+T cells increased (P0.01), CD3+ and NK increased the proportion of cells (P0.05). Compared to the control group of RAU and general health, only the proportion of CD4+T cells decreased (P0.05). Conclusion: the patients with]RAU lymph Cell subsets imbalance, including cellular immunity in patients with refractory RAU changed more significantly. The third part of the immune level of thalidomide in the treatment of his ulcer intractable recurrent aphthous effect [Objective] to observe the clinical effect of thalidomide in short-term treatment of refractory RAU, detection and analysis of thalidomide in the treatment of refractory RAU patients before and after peripheral blood immune index the change, to explore the effect of thalidomide in the treatment of immune level in patients with refractory RAU, for studying the mechanism of action of thalidomide in the treatment of intractable RAU. To provide experimental basis for the selection of methods of refractory RAU patients and 80 healthy control group of 80 cases of thalidomide in the treatment of refractory RAU patients, to observe the 1 months of treatment and withdrawal of clinical the effect of 2 months, by immunoturbidimetry method, determination of peripheral blood immunoglobulin ECLIA and of thalidomide in the treatment of refractory RAU patients 1 months after flow cytometry The proportion of protein, complement levels and lymphocyte subsets, and record the clinical curative effect, using SPSS 18 statistical software for statistical analysis. Results of thalidomide in the treatment of refractory RAU1 months and 2 months after drug withdrawal, the intermittent period is prolonged, the healing time was shortened, the number of ulcer attack is reduced, VAS reduced pain scores (P0.05). But compared to drug withdrawal for 2 months and 1 months of treatment efficacy decreased. After 1 months of treatment with immunoglobulin and complement IgG, IgA, C3 and C4 decreased (P0.05), CD4+T cell subsets in the proportion of lymphocytes increased (P0.05). Conclusion: Thalidomide clinical curative effect of the treatment of refractory RAU significantly thalidomide in the treatment of refractory RAU, the patient's immune level affects the regulation of humoral and cellular immune function may be one of the mechanisms of the treatment of refractory RAU.

【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R781.5
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本文编号：1587756