狼疮性肾炎患者外周血干细胞因子的检测及临床意义
发布时间：2018-07-24 12:18
【摘要】：目的:通过检测狼疮性肾炎(lupus nephritis,LN)患者血清干细胞因子(stem cell factor,SCF)水平,并与健康对照组比较,再针对不同临床疾病活动度、不同病理类型、不同治疗效果的LN患者血清SCF水平进行组间比较,分析血清SCF水平在LN患者中是否存在异常、在不同LN患者中是否存在差异,以及这种异常与疾病活动度、病理类型、疾病的难治程度等因素是否相关,进一步探讨SCF在LN发病机制中的可能作用。方法:选取2014年3月-2016年9月在山东省济宁市第一人民医院肾内科住院且经肾活检确诊的LN患者为研究对象,纳入符合标准的患者共计60例。收集患者的一般临床资料,包含年龄、性别、体重、病程时间、主要症状及伴随症状、阳性体征等;完善临床指标的检测,包括血常规、血沉(ESR)、生化全项、尿常规、24小时尿蛋白定量(UTP)、尿红细胞相差显微镜检查、补体C3、补体C4、抗核抗体(ANA)滴度、抗双链脱氧核糖核酸抗体(ds-DNA)定量、抗核抗体谱等;完成估计的肾小球滤过率(e GFR)的计算;完成红斑狼疮疾病的活动度评分(SLEDAI-2000);收集其LN肾脏病理类型并计算LN肾脏病理活动指数(AI)、肾脏病理慢性指数(CI)、肾小管间质病变积分(TIL)。根据SLEDAI-2000评分将LN患者分为狼疮活动组(30例)、狼疮稳定组(30例);根据狼疮性肾炎病理分型标准将LN患者分成6组,分别是Ⅱ型LN(7例)、Ⅲ型LN(10例)、Ⅳ型LN(13例)、Ⅴ型LN(15例)、Ⅴ+Ⅲ型LN(8例)、Ⅴ+Ⅳ型LN(7例);再根据治疗效果分成2组,分别是难治狼疮组(19例)及治疗敏感组(32例)。另设健康体检中心的健康体检者作为健康对照组(30例),完善血常规、ESR、生化全项、补体C3、补体C4等检查,完成e GFR计算。采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)的方法检测LN患者及健康对照组的血清SCF表达水平、分析其水平在各组间是否存在差异;并用Spearman相关分析法分析LN患者血清SCF表达水平与一般临床指标、疾病活动指标、肾脏病理指标的相关性。结果:各组患者性别、年龄间差异无统计学意义(P0.05)。LN组血清SCF水平(332.87±56.37)ng/L显著高于健康对照组(154.06±22.49)ng/L(P(27)0.01)。狼疮活动组SCF水平(357.29±63.85)ng/L显著高于狼疮稳定组(310.03±40.17)ng/L(P(27)0.01)。Ⅲ型、Ⅳ型LN组的SCF水平分别明显高于Ⅱ型、Ⅴ型LN组(c2=45.38,P(27)0.05)。难治狼疮组在规范治疗前的SCF水平(357.29±63.85)ng/L明显高于治疗敏感组(310.03±40.17)ng/L(t=2.633,P(27)0.05)。LN组血清SCF水平与UTP、抗ds-DNA定量、ANA滴度、SLEDAI积分、AI指数、TIL积分呈正相关(r=0.297,r=0.353,r=0.285,r=0.469,r=0.390,r=0.317,P均(27)0.05);与补体C3、补体C4呈负相关(r=-0.321,r=-0.361,P(27)0.05);与血清肌酐水平(Scr)、e GFR、CI指数无相关性(r=0.213,r=-0.144,r=-0.181,P0.05)。结论:1.LN患者的血清SCF水平高于健康人,提示着SCF可能参与了LN的发生发展过程。2.狼疮活动组的血清SCF水平明显高于狼疮稳定组,且LN患者血清SCF水平与LN的临床活动指标、肾脏病理活动指标有一定的相关性,提示着血清SCF水平可作为判断LN疾病活动的血清学监测指标之一。3.Ⅲ型、Ⅳ型LN组的SCF水平分别明显高于Ⅱ型、Ⅴ型LN组,提示着血清SCF水平可能与LN的肾脏病理类型、病理增殖的程度有一定的关系。4.难治狼疮组的血清SCF水平明显高于治疗敏感组,提示血清SCF表达水平对狼疮性肾炎预后的判断具有一定的预测作用。
[Abstract]:Objective: To compare the serum levels of stem cell factor (SCF) in patients with lupus nephritis (LN), and compare with the healthy control group, and then compare the serum SCF levels of LN patients with different clinical disease activity, different pathological types and different therapeutic effects, and analyze whether the serum SCF level is in LN patients. There are differences in different LN patients, and whether the abnormalities are related to the degree of disease activity, pathological type, and the degree of refractory disease, and further explore the possible role of SCF in the pathogenesis of LN. Methods: in March 2014, -2016 year, in the first people's Hospital of Jining, Shandong Province, in the nephrology department and the kidney. A total of 60 patients with a biopsy confirmed LN were included. The general clinical data of patients were collected, including age, sex, weight, duration of disease, main symptoms and symptoms, positive signs, etc., and the improvement of clinical indicators, including blood routine, ESR, biochemical total, urine routine, and 24 hour urine protein quantitative. UTP), urinary red cell phase contrast microscope, complement C3, complement C4, anti nuclear antibody (ANA) titer, anti double chain deoxyribonucleic antibody (ds-DNA) quantitative, anti nuclear antibody spectrum, calculation of estimated glomerular filtration rate (E GFR), completion of activity score (SLEDAI-2000) of lupus erythematosus disease (SLEDAI-2000), collecting its LN renal pathological type and calculating LN kidney. The pathological activity index (AI), renal pathological chronic index (CI) and renal tubulointerstitial lesion score (TIL). According to the SLEDAI-2000 score, the patients were divided into lupus active group (30 cases) and lupus stable group (30 cases); LN patients were divided into 6 groups according to the pathological classification standard of lupus nephritis, which were type II LN (7 cases), type III LN (10 cases), type IV LN (13 cases), type V LN. (15 cases), type V + III type LN (8 cases), V + IV type LN (7 cases), and then divided into 2 groups according to the therapeutic effect, which are refractory lupus erythematosus group (19 cases) and treatment sensitive group (32 cases). Another healthy physical examination center in health examination center (30 cases), complete blood routine, ESR, biochemical whole term, complement C3, complement C4 and so on, complete e GFR calculation. Enzyme linked exemption. Enzyme linked immunosorbent assay (ELISA) was used to detect the level of SCF expression in the serum of LN patients and healthy controls, and to analyze the difference between the levels of the serum SCF and the level of the serum SCF in each group, and to analyze the level of the serum SCF expression of LN patients with the general bed index, the index of disease activity and the pathological indexes of kidney by the Spearman correlation analysis. Results: there was no significant difference between the sex and age of the patients in each group (P0.05) the level of serum SCF in.LN group (332.87 + 56.37) was significantly higher than that in the healthy control group (154.06 + 22.49) ng/L (P (27) 0.01). The SCF level (357.29 + 63.85) ng/L in the lupus activity group was significantly higher than that in the group of lupus stabilization (310.03 + 40.17) ng/L (P (27) 0.01). Type III and type IV LN group SCF water The level of flat score was significantly higher than that of type II, type V LN (c2=45.38, P (27) 0.05). The level of SCF (357.29 + 63.85) in the refractory lupus group (357.29 + 63.85) before treatment was significantly higher than that in the treatment sensitive group (310.03 + 40.17) ng/L (t=2.633, P (27) 0.05) in the.LN group, and the serum SCF level was positively correlated with UTP. 353, r=0.285, r=0.469, r=0.390, r=0.317, P all (27) 0.05), and the complement C3, the complement C4 is negative correlation (r=-0.321, r=-0.361, P (27) 0.05), and the serum creatinine level (Scr). The level of serum SCF in the activity group of.2. lupus erythematosus was significantly higher than that of the stable lupus erythematosus group, and the serum SCF level of the LN patients was related to the index of clinical activity of LN and the index of renal pathological activity. It suggested that the serum SCF level could be used as one of the serological monitoring indexes of LN disease activity, and the SCF level of the group IV LN group was higher, respectively. In type II and type V LN group, the level of serum SCF may be related to the pathological type of kidney and the degree of pathological proliferation of LN. The serum SCF level of.4. refractory lupus erythematosus group is obviously higher than that of the treatment sensitive group, which suggests that the level of serum SCF expression has a certain predictive effect on the prognosis of lupus nephritis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.242
本文编号：2141357
[Abstract]:Objective: To compare the serum levels of stem cell factor (SCF) in patients with lupus nephritis (LN), and compare with the healthy control group, and then compare the serum SCF levels of LN patients with different clinical disease activity, different pathological types and different therapeutic effects, and analyze whether the serum SCF level is in LN patients. There are differences in different LN patients, and whether the abnormalities are related to the degree of disease activity, pathological type, and the degree of refractory disease, and further explore the possible role of SCF in the pathogenesis of LN. Methods: in March 2014, -2016 year, in the first people's Hospital of Jining, Shandong Province, in the nephrology department and the kidney. A total of 60 patients with a biopsy confirmed LN were included. The general clinical data of patients were collected, including age, sex, weight, duration of disease, main symptoms and symptoms, positive signs, etc., and the improvement of clinical indicators, including blood routine, ESR, biochemical total, urine routine, and 24 hour urine protein quantitative. UTP), urinary red cell phase contrast microscope, complement C3, complement C4, anti nuclear antibody (ANA) titer, anti double chain deoxyribonucleic antibody (ds-DNA) quantitative, anti nuclear antibody spectrum, calculation of estimated glomerular filtration rate (E GFR), completion of activity score (SLEDAI-2000) of lupus erythematosus disease (SLEDAI-2000), collecting its LN renal pathological type and calculating LN kidney. The pathological activity index (AI), renal pathological chronic index (CI) and renal tubulointerstitial lesion score (TIL). According to the SLEDAI-2000 score, the patients were divided into lupus active group (30 cases) and lupus stable group (30 cases); LN patients were divided into 6 groups according to the pathological classification standard of lupus nephritis, which were type II LN (7 cases), type III LN (10 cases), type IV LN (13 cases), type V LN. (15 cases), type V + III type LN (8 cases), V + IV type LN (7 cases), and then divided into 2 groups according to the therapeutic effect, which are refractory lupus erythematosus group (19 cases) and treatment sensitive group (32 cases). Another healthy physical examination center in health examination center (30 cases), complete blood routine, ESR, biochemical whole term, complement C3, complement C4 and so on, complete e GFR calculation. Enzyme linked exemption. Enzyme linked immunosorbent assay (ELISA) was used to detect the level of SCF expression in the serum of LN patients and healthy controls, and to analyze the difference between the levels of the serum SCF and the level of the serum SCF in each group, and to analyze the level of the serum SCF expression of LN patients with the general bed index, the index of disease activity and the pathological indexes of kidney by the Spearman correlation analysis. Results: there was no significant difference between the sex and age of the patients in each group (P0.05) the level of serum SCF in.LN group (332.87 + 56.37) was significantly higher than that in the healthy control group (154.06 + 22.49) ng/L (P (27) 0.01). The SCF level (357.29 + 63.85) ng/L in the lupus activity group was significantly higher than that in the group of lupus stabilization (310.03 + 40.17) ng/L (P (27) 0.01). Type III and type IV LN group SCF water The level of flat score was significantly higher than that of type II, type V LN (c2=45.38, P (27) 0.05). The level of SCF (357.29 + 63.85) in the refractory lupus group (357.29 + 63.85) before treatment was significantly higher than that in the treatment sensitive group (310.03 + 40.17) ng/L (t=2.633, P (27) 0.05) in the.LN group, and the serum SCF level was positively correlated with UTP. 353, r=0.285, r=0.469, r=0.390, r=0.317, P all (27) 0.05), and the complement C3, the complement C4 is negative correlation (r=-0.321, r=-0.361, P (27) 0.05), and the serum creatinine level (Scr). The level of serum SCF in the activity group of.2. lupus erythematosus was significantly higher than that of the stable lupus erythematosus group, and the serum SCF level of the LN patients was related to the index of clinical activity of LN and the index of renal pathological activity. It suggested that the serum SCF level could be used as one of the serological monitoring indexes of LN disease activity, and the SCF level of the group IV LN group was higher, respectively. In type II and type V LN group, the level of serum SCF may be related to the pathological type of kidney and the degree of pathological proliferation of LN. The serum SCF level of.4. refractory lupus erythematosus group is obviously higher than that of the treatment sensitive group, which suggests that the level of serum SCF expression has a certain predictive effect on the prognosis of lupus nephritis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.242
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