虚实性体质系统性红斑狼疮患者外周血T、B淋巴细胞Fas表达及凋亡的初步研究

发布时间：2018-06-22 05:57

本文选题：系统性红斑狼疮 + 中医体质　；参考：《广州中医药大学》2016年硕士论文

【摘要】：系统性红斑狼疮(SLE)是一种累及多系统多器官,临床表现复杂,病程迁延反复的自身免疫性疾病,其病因及发病机制非常复杂,与遗传、免疫紊乱、环境因素、性别因素等密切相关,至今尚未完全明确。现代医学研究认为凋亡细胞清除缺陷和T、B淋巴细胞凋亡异常是SLE发病的重要原因,Fas作为介导淋巴细胞凋亡的主要膜受体,与SLE发病有关。中医认为体质是疾病发生、发展的重要因素,体质对于揭示疾病病因有独特的优势。因此把中医体质学观点和现代医学研究成果相结合,有利于揭示SLE的发病原因,为SLE的中医药防治奠定更科学的理论基础。目的：本课题通过比较虚性体质和实性体质系统性红斑狼疮患者的外周血T、B淋巴细胞Fas表达率及凋亡率,探讨系统性红斑狼疮发病的中医本质及机理,为中医药有效防治系统性红斑狼疮提供更科学的理论依据。方法：研究收集2015年8月至2016年2月广州中医药大学第一附属医院风湿病科门诊及住院部符合SLE分类标准的病人共46例,收集病人姓名、年龄、性别、病程等一般情况资料；按照2009年4月9日实施的《中医体质分类与判定》标准判定体质状况,把阳虚体质、阴虚体质、气虚体质归为虚性体质,气郁体质、痰湿体质、瘀血体质、湿热体质归为实性体质,特禀质及平和质暂不纳入虚、实性体质研究范围；并结合患者病情进行狼疮疾病活动指数评分(SLEDAI评分)；每一位患者抽取静脉血,采用流式细胞术检测T淋巴细胞Fas表达率、B淋巴细胞Fas表达率以及T、B淋巴细胞凋亡率；最后采用spss22.0统计软件将以上数据作统计学分析,比较虚性体质和实性体质SLE患者的T、B淋巴细胞Fas表达率及凋亡率,并对T、B淋巴细胞Fas表达率及凋亡率与抗ds-DNA水平、SLE疾病活动评分进行相关性分析,得出结论。结果：1.虚性体质的SLE患者的外周血T淋巴凋亡率显著高于实性体质SLE患者。2.SLE患者外周血T淋巴细胞Fas表达率与SLE疾病活动度、抗ds-DNA抗体水平正相关。3.活动期SLE患者外周血B淋巴细胞Fas表达率与B淋巴细胞凋亡率正相关。结论：1.本次研究发现虚性体质组的T淋巴细胞凋亡率较实性体质组显著升高。目前经大量研究证实SLE外周血T淋巴细胞凋亡率较健康人升高,反映了SLE患者存在凋亡物质清除缺陷,这与SLE发病密切相关。因而我们认为虚性体质人群较实性体质人群具有更明显的凋亡物质清除缺陷,因而更容易患SLE。这揭示了SLE患者以虚性体质常见的原因,也和中医认为SLE的病机是以先天禀赋不足,正气亏虚为本的这一认识相一致,因而我们可以认为“体虚”为SLE发病之本。2.SLE患者外周血T淋巴细胞Fas表达率与SLE疾病活动度、抗ds-DNA水平正相关,因此外周血T淋巴细胞Fas表达率在评估SLE疾病活动度方面具有重要价值。3.Fas介导的细胞凋亡途径可能是活动期SLE患者外周血B淋巴细胞凋亡的主要途径。
[Abstract]:Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple systems and organs with complex clinical manifestations and repeated course of disease. Gender factors and other closely related, so far has not been completely clear. Modern medical studies suggest that the defect of apoptotic cell clearance and the abnormal apoptosis of T _ (B) B lymphocytes are the important reasons for the pathogenesis of SLE. FAS is the main membrane receptor that mediates the apoptosis of lymphocytes, which is related to the pathogenesis of SLE. TCM believes that physique is an important factor in the occurrence and development of disease, and physique has a unique advantage in revealing the etiology of disease. Therefore, combining the viewpoint of TCM physique with the research results of modern medicine is helpful to reveal the pathogenesis of SLE and to lay a more scientific theoretical foundation for the prevention and treatment of SLE by TCM. Objective: to investigate the nature and mechanism of systemic lupus erythematosus (SLE) by comparing the FAS expression rate and apoptosis rate of peripheral blood TnB lymphocytes in patients with systemic lupus erythematosus (SLE). To provide a more scientific theoretical basis for the effective prevention and treatment of systemic lupus erythematosus by traditional Chinese medicine. Methods: from August 2015 to February 2016, 46 patients in the Department of Rheumatology, Department of Rheumatology, first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, who met the classification criteria of SLE, were collected and their names, age, sex and course of disease were collected. According to the standard of TCM constitution classification and judgment implemented on April 9, 2009, the constitution of yang deficiency, yin deficiency and qi deficiency were classified as deficiency constitution, qi depression constitution, phlegm dampness constitution, blood stasis constitution. The dampness and heat constitution is classified as the solid constitution, the special quality and the calming quality are not included in the study of deficiency, and the physical fitness is studied. The disease activity index score (SLEDAI score) is carried out according to the condition of the patient. Each patient takes the venous blood. Flow cytometry was used to detect the FAS expression rate of T lymphocytes, the FAS expression rate of B lymphocytes and the apoptosis rate of B lymphocytes. Finally, the above data were statistically analyzed by spss22.0 software. To compare the FAS expression rate and apoptosis rate between asthenia and solid constitution SLE patients, and to analyze the correlation between FAS expression rate and apoptosis rate and anti-ds-DNA level of SLE disease activity score. The result is 1: 1. The rate of T lymphoid apoptosis in SLE patients with asthenia constitution was significantly higher than that in SLE patients with solid constitution. 2. The FAS expression rate of peripheral blood T lymphocytes in SLE patients was positively correlated with disease activity and anti-ds-DNA antibody level. There was a positive correlation between FAS expression and B lymphocyte apoptosis in active SLE patients. Conclusion 1. The apoptosis rate of T lymphocytes in asthenia constitution group was significantly higher than that in solid constitution group. At present, a large number of studies have confirmed that the apoptosis rate of T lymphocytes in peripheral blood of SLE is higher than that of healthy persons, which indicates that there is a defect in the clearance of apoptotic substances in SLE patients, which is closely related to the pathogenesis of SLE. Therefore, we think that the deficiency body population has more obvious apoptotic substance clearance defect than the real physical group, so it is more likely to suffer from SLE. This reveals the common causes of asthenia in SLE patients, and is consistent with the Chinese medicine's understanding that the pathogenesis of SLE is based on the deficiency of innate endowment and deficiency of qi. Therefore, we can conclude that "body deficiency" is the origin of SLE. 2. There is a positive correlation between FAS expression rate in peripheral blood T lymphocytes and disease activity and anti-ds-DNA level in SLE patients. Therefore, the expression rate of FAS in peripheral blood T lymphocytes has important value in evaluating the disease activity of SLE. 3. FAS mediated apoptosis may be the main pathway of peripheral blood B lymphocyte apoptosis in active SLE patients.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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