本文選題：頑固性RAU　切入點(diǎn)：免疫球蛋白　出處：《南京大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：第一部分頑固性復(fù)發(fā)性阿弗他潰瘍患者外周血免疫球蛋白及補(bǔ)體的改變[目的]觀察RAU患者外周血免疫球蛋白及補(bǔ)體水平的改變,同時(shí)比較頑固性RAU和普通性RAU改變的差異,為探討RAU發(fā)病機(jī)理提供實(shí)驗(yàn)依據(jù)。[方法]收集頑固性RAU患者329例,普通性RAU患者296例及健康對(duì)照組217例,采用免疫比濁法測(cè)定免疫球蛋白和補(bǔ)體(IgG、IgA、IgM、C3和C4),根據(jù)多點(diǎn)校準(zhǔn)品濃度和對(duì)應(yīng)吸光度變化值ΔA,采用非線(xiàn)性校準(zhǔn)法log(4p)確定工作曲線(xiàn),所測(cè)樣本吸光度變化在工作曲線(xiàn)上相對(duì)應(yīng)的濃度值即為所測(cè)濃度。IgE采用電化學(xué)發(fā)光法測(cè)定,檢測(cè)結(jié)果由機(jī)器自動(dòng)從標(biāo)準(zhǔn)曲線(xiàn)上獲得。對(duì)結(jié)果采用SPSS 18.0統(tǒng)計(jì)軟件進(jìn)行檢驗(yàn),檢驗(yàn)水準(zhǔn)為雙側(cè)α = 0.05。[結(jié)果]RAU患者免疫球蛋白(IgG、IgA、IgM、IgE)及補(bǔ)體(C3、C4)水平升高;頑固性RAU和普通性RAU患者比較可示,IgG、IgA、IgE升高(P0.01),C3、C4升高(P0.05);與健康對(duì)照組比較,頑固性RAU IgG、IgA、IgE和C3、C4升高(P0.01)。而普通性RAU與健康對(duì)照組比較,免疫球蛋白水平未出現(xiàn)差異(P0.05),C3和C4升高(P分別為P0.01、P0.05)。[結(jié)論]RAU患者免疫球蛋白和補(bǔ)體水平升高,其中頑固性RAU患者免疫球蛋白水平升高更為明顯。第二部分頑固性復(fù)發(fā)性阿弗他潰瘍患者外周血淋巴細(xì)胞亞群比例的變化[目的]本研究對(duì)RAU患者淋巴細(xì)胞亞群比例進(jìn)行綜合分析,探討頑固性RAU、普通性RAU及健康對(duì)照組淋巴細(xì)胞亞群比例并進(jìn)行比較與分析,為深入探究RAU的發(fā)病機(jī)制提供實(shí)驗(yàn)依據(jù)。[方法]收集頑固性RAU患者329例,普通性RAU患者296例及健康對(duì)照組217例,淋巴細(xì)胞亞群(CD19+、CD3+、CD4+、CD8+、NK)比例采用流式細(xì)胞術(shù)檢測(cè),使用BD CellQuest Pro軟件采集和分析列表模式數(shù)據(jù)。[結(jié)果]RAU患者淋巴細(xì)胞比例中CD4+和CD4+/CD8+下降,CD8+T和NK升高(P0.01)。頑固性RAU和普通性RAU比較,CD19+和CD4+/CD8+細(xì)胞比例下降,CD8+T細(xì)胞比例升高(P0.01);頑固性RAU與健康對(duì)照組比較,CD19+、CD4+T細(xì)胞比例和CD4+/CD8+比值下降,CD8+T細(xì)胞比例升高(P0.01),CD3+和NK細(xì)胞比例升高(P0.05)。普通性RAU與健康對(duì)照組比較,僅出現(xiàn)CD4+T細(xì)胞比例下降(P0.05)。[結(jié)論]RAU患者淋巴細(xì)胞亞群比例失衡,其中頑固性RAU患者細(xì)胞免疫改變幅度更加明顯。第三部分沙利度胺治療對(duì)頑固性復(fù)發(fā)性阿弗他潰瘍免疫水平的影響[目的]觀察沙利度胺治療頑固性RAU的短期臨床療效,檢測(cè)并分析沙利度胺治療頑固性RAU患者前、后外周血免疫指標(biāo)的改變,探討沙利度胺治療頑固性RAU患者免疫水平的影響,為研究沙利度胺治療頑固性RAU的作用機(jī)制提供實(shí)驗(yàn)依據(jù)。[方法]選擇頑固性RAU患者80例和健康對(duì)照組80例,對(duì)沙利度胺治療頑固性RAU患者,觀察其治療1個(gè)月和停藥2個(gè)月臨床療效,采用免疫比濁法、電化學(xué)發(fā)光法和流式細(xì)胞術(shù)對(duì)沙利度胺治療頑固性RAU患者1個(gè)月后測(cè)定其外周血免疫球蛋白、補(bǔ)體水平及淋巴細(xì)胞亞群比例,并記錄臨床療效,采用SPSS 18.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。[結(jié)果]沙利度胺治療頑固性RAU1個(gè)月和停藥2個(gè)月后,間歇期延長(zhǎng),愈合時(shí)間縮短,潰瘍發(fā)作時(shí)的數(shù)目減少,VAS疼痛評(píng)分降低(P0.05),但停藥2個(gè)月與治療1個(gè)月療效相比有減弱趨勢(shì)。治療1個(gè)月后免疫球蛋白及補(bǔ)體中IgG、IgA、C3和C4水平降低(P0.05),淋巴細(xì)胞亞群中CD4+T細(xì)胞比例升高(P0.05)。[結(jié)論]沙利度胺治療頑固性RAU的臨床療效明顯,沙利度胺治療對(duì)頑固性RAU患者的免疫水平產(chǎn)生了一定影響,調(diào)節(jié)體液和細(xì)胞免疫的作用可能是其治療頑固性RAU的機(jī)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.

【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R781.5
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本文編號(hào)：1587756