白塞病血循环内皮微粒的检测及临床意义分析
发布时间：2018-10-23 18:51
【摘要】：目的:白塞病(Behcet’s disease,BD)白塞病是一种病因不明、多系统受累的炎症性疾病,其疾病特点是复发性眼炎,口腔及生殖器溃疡,皮肤损害,也可有多系统受累,包括胃肠道、血管、神经系统等。BD多累及20~40岁青壮年,自然病程呈现缓解与复发交替出现,迁延反复,病情严重者可导致失明、心血管及中枢神经系统严重病变,常给患者带来巨大的精神压力和经济负担。虽然目前疾病发病机制仍不清楚,目前认为其发病机制可能与宿主遗传易感性与易感环境相互作用相关。多数学者认为BD是一种多系统受累的血管炎性疾病,其组织病理学特点是血管周围白细胞聚集增加,白细胞外渗到组织的程度取决于血管内皮细胞的完整性及表面表达的粘附分子。大量研究显示内皮功能障碍是血管病变的始动因素,内皮功能损伤为其血管炎发病机制之一。目前无论BD分类标准,还是其活动度评估均以临床评估为主,均缺乏特异的客观评估指标。因此,寻找一种能评估BD疾病活动度及预测该疾病严重程度的指标刻不容缓。内皮微粒(Endothelial cell-derived microparticles,EMPs)是一种内皮细胞激活或凋亡时释放的一种复杂的囊泡样结构。EMP不仅可以反映内细胞的激活或损伤状态,而且可以调节炎症反应、凝血和血管功能。血浆中EMPs水平是新近发展的一种评估内皮功能损伤的方法。因此,本研究集中探讨EMPs是否可作为评估白塞病系统受累情况及其疾病活动度新的指标。方法:本研究共纳入39例满足1990年白塞病国际诊断标准或2013年国际白塞病研究组发布了最新的白塞病国际标准和30例性别和年龄相匹配的健康者作为对照组。采用流式细胞仪检测血浆中CD31+/CD42b-内皮微粒水平。采用白塞病疾病活动窗(Behcet’s disease current activity form,BDCAF)和入组时伯明翰血管炎活动评分系统(Birmingham Vasculitis Activity Score,BVAS)对BD患者病情活动度进行评估。结果:BD患者血浆EMPs水平明显高于健康对照组(p=0.000)。BD患者血浆EMPs水平与BDCAF呈正相关(r=0.802,p=0.000),与BVAS呈正相关(r=0.607,p=0.000)有血管受累BD患者血浆EMPs水平较无血管受累患者显著升高(p=0.000)。有消化道受累BD患者血浆EMPs水平较无消化道受累患者显著升高,差异有统计学意义(p=0.011)。BD患者血浆EMPs水平在性别、皮疹、神经系统受累、眼炎、关节症状及针刺试验是否阳性之间无显著差异。结论:BD患者血浆EMP水平明显高于健康对照组,且与疾病活动度相关,提示上述指标可能成为预测BD疾病活动度新的指标;BD患者血浆EMPs水平升高,提示血管和消化道受累风险增加。
[Abstract]:Objective: Behcet's disease (Behcet's disease,BD) is an inflammatory disease characterized by recurrent ophthalmitis, oral and genital ulcers, skin damage, or multiple system involvement, including gastrointestinal tract and blood vessels. Nervous system and so on. BD mostly involves 2040 years of age, and the natural course of disease appears alternately remission and recurrence. If the disease is severe, it can lead to blindness, severe cardiovascular and central nervous system diseases. Often bring great mental pressure and economic burden to patients. Although the pathogenesis of the disease is still unclear, it is believed that its pathogenesis may be related to the interaction between host genetic susceptibility and susceptible environment. Most scholars believe that BD is a vasculitis disease with multiple systems, and its histopathology is characterized by increased leukocyte aggregation around blood vessels. The extent of leucocyte exosmosis to the tissue depends on the integrity of vascular endothelial cells and the expression of adhesion molecules on the surface. A large number of studies show that endothelial dysfunction is the initiator of vascular disease, endothelial dysfunction is one of the pathogenesis of vasculitis. At present, both BD classification standard and its activity are mainly evaluated by clinical evaluation, and there is no specific objective evaluation index. Therefore, it is urgent to find an index to evaluate the activity of BD disease and predict the severity of the disease. Endothelial microparticles (Endothelial cell-derived microparticles,EMPs) are a complex vesicular structure released when endothelial cells are activated or apoptotic. EMP can not only reflect the activation or damage of inner cells, but also regulate inflammation, coagulation and vascular function. Plasma EMPs level is a newly developed method for evaluating endothelial dysfunction. Therefore, this study focuses on whether EMPs can be used as a new indicator for evaluating the involvement of Behcet's disease system and its disease activity. Methods: a total of 39 patients who met the international diagnostic criteria for Behcet disease in 1990 or the international study group of Behcet disease in 2013 published the latest international criteria for Behcet disease and 30 healthy persons matched for sex and age as control group. The level of CD31 / CD42b- endothelial particles in plasma was measured by flow cytometry. Behcet disease activity window (Behcet's disease current activity form,BDCAF) and Birmingham vasculitis activity scoring system (Birmingham Vasculitis Activity Score,BVAS) were used to evaluate the disease activity of BD patients. Results: the plasma EMPs level in patients with BD was significantly higher than that in healthy controls (P < 0. 000). There was a positive correlation between plasma EMPs and BDCAF (r = 0. 802, P 0. 000), and a positive correlation with BVAS (r = 0. 607, P 0. 000). The level of plasma EMPs in BD patients with vascular involvement was significantly higher than that in patients without vascular involvement (p0. 000). The plasma EMPs level in patients with digestive tract involvement BD was significantly higher than that in patients without digestive tract involvement, and the difference was statistically significant (p0.011). BD patients with EMPs in sex, rash, nervous system involvement, ophthalmitis. There was no significant difference between the joint symptoms and whether the acupuncture test was positive. Conclusion: the plasma EMP level in BD patients is significantly higher than that in healthy controls, and is related to disease activity, suggesting that the above indexes may be a new index to predict the disease activity of BD, and the plasma EMPs level in BD patients is higher than that in healthy controls. The results suggest that the risk of vascular and digestive tract involvement is increased.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R597.9
[Abstract]:Objective: Behcet's disease (Behcet's disease,BD) is an inflammatory disease characterized by recurrent ophthalmitis, oral and genital ulcers, skin damage, or multiple system involvement, including gastrointestinal tract and blood vessels. Nervous system and so on. BD mostly involves 2040 years of age, and the natural course of disease appears alternately remission and recurrence. If the disease is severe, it can lead to blindness, severe cardiovascular and central nervous system diseases. Often bring great mental pressure and economic burden to patients. Although the pathogenesis of the disease is still unclear, it is believed that its pathogenesis may be related to the interaction between host genetic susceptibility and susceptible environment. Most scholars believe that BD is a vasculitis disease with multiple systems, and its histopathology is characterized by increased leukocyte aggregation around blood vessels. The extent of leucocyte exosmosis to the tissue depends on the integrity of vascular endothelial cells and the expression of adhesion molecules on the surface. A large number of studies show that endothelial dysfunction is the initiator of vascular disease, endothelial dysfunction is one of the pathogenesis of vasculitis. At present, both BD classification standard and its activity are mainly evaluated by clinical evaluation, and there is no specific objective evaluation index. Therefore, it is urgent to find an index to evaluate the activity of BD disease and predict the severity of the disease. Endothelial microparticles (Endothelial cell-derived microparticles,EMPs) are a complex vesicular structure released when endothelial cells are activated or apoptotic. EMP can not only reflect the activation or damage of inner cells, but also regulate inflammation, coagulation and vascular function. Plasma EMPs level is a newly developed method for evaluating endothelial dysfunction. Therefore, this study focuses on whether EMPs can be used as a new indicator for evaluating the involvement of Behcet's disease system and its disease activity. Methods: a total of 39 patients who met the international diagnostic criteria for Behcet disease in 1990 or the international study group of Behcet disease in 2013 published the latest international criteria for Behcet disease and 30 healthy persons matched for sex and age as control group. The level of CD31 / CD42b- endothelial particles in plasma was measured by flow cytometry. Behcet disease activity window (Behcet's disease current activity form,BDCAF) and Birmingham vasculitis activity scoring system (Birmingham Vasculitis Activity Score,BVAS) were used to evaluate the disease activity of BD patients. Results: the plasma EMPs level in patients with BD was significantly higher than that in healthy controls (P < 0. 000). There was a positive correlation between plasma EMPs and BDCAF (r = 0. 802, P 0. 000), and a positive correlation with BVAS (r = 0. 607, P 0. 000). The level of plasma EMPs in BD patients with vascular involvement was significantly higher than that in patients without vascular involvement (p0. 000). The plasma EMPs level in patients with digestive tract involvement BD was significantly higher than that in patients without digestive tract involvement, and the difference was statistically significant (p0.011). BD patients with EMPs in sex, rash, nervous system involvement, ophthalmitis. There was no significant difference between the joint symptoms and whether the acupuncture test was positive. Conclusion: the plasma EMP level in BD patients is significantly higher than that in healthy controls, and is related to disease activity, suggesting that the above indexes may be a new index to predict the disease activity of BD, and the plasma EMPs level in BD patients is higher than that in healthy controls. The results suggest that the risk of vascular and digestive tract involvement is increased.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R597.9
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