狼瘡性腎炎患者外周血干細(xì)胞因子的檢測(cè)及臨床意義
發(fā)布時(shí)間：2018-07-24 12:18
【摘要】：目的:通過(guò)檢測(cè)狼瘡性腎炎(lupus nephritis,LN)患者血清干細(xì)胞因子(stem cell factor,SCF)水平,并與健康對(duì)照組比較,再針對(duì)不同臨床疾病活動(dòng)度、不同病理類型、不同治療效果的LN患者血清SCF水平進(jìn)行組間比較,分析血清SCF水平在LN患者中是否存在異常、在不同LN患者中是否存在差異,以及這種異常與疾病活動(dòng)度、病理類型、疾病的難治程度等因素是否相關(guān),進(jìn)一步探討SCF在LN發(fā)病機(jī)制中的可能作用。方法:選取2014年3月-2016年9月在山東省濟(jì)寧市第一人民醫(yī)院腎內(nèi)科住院且經(jīng)腎活檢確診的LN患者為研究對(duì)象,納入符合標(biāo)準(zhǔn)的患者共計(jì)60例。收集患者的一般臨床資料,包含年齡、性別、體重、病程時(shí)間、主要癥狀及伴隨癥狀、陽(yáng)性體征等;完善臨床指標(biāo)的檢測(cè),包括血常規(guī)、血沉(ESR)、生化全項(xiàng)、尿常規(guī)、24小時(shí)尿蛋白定量(UTP)、尿紅細(xì)胞相差顯微鏡檢查、補(bǔ)體C3、補(bǔ)體C4、抗核抗體(ANA)滴度、抗雙鏈脫氧核糖核酸抗體(ds-DNA)定量、抗核抗體譜等;完成估計(jì)的腎小球?yàn)V過(guò)率(e GFR)的計(jì)算;完成紅斑狼瘡疾病的活動(dòng)度評(píng)分(SLEDAI-2000);收集其LN腎臟病理類型并計(jì)算LN腎臟病理活動(dòng)指數(shù)(AI)、腎臟病理慢性指數(shù)(CI)、腎小管間質(zhì)病變積分(TIL)。根據(jù)SLEDAI-2000評(píng)分將LN患者分為狼瘡活動(dòng)組(30例)、狼瘡穩(wěn)定組(30例);根據(jù)狼瘡性腎炎病理分型標(biāo)準(zhǔn)將LN患者分成6組,分別是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);再根據(jù)治療效果分成2組,分別是難治狼瘡組(19例)及治療敏感組(32例)。另設(shè)健康體檢中心的健康體檢者作為健康對(duì)照組(30例),完善血常規(guī)、ESR、生化全項(xiàng)、補(bǔ)體C3、補(bǔ)體C4等檢查,完成e GFR計(jì)算。采用酶聯(lián)免疫吸附試驗(yàn)(enzyme linked immunosorbent assay,ELISA)的方法檢測(cè)LN患者及健康對(duì)照組的血清SCF表達(dá)水平、分析其水平在各組間是否存在差異;并用Spearman相關(guān)分析法分析LN患者血清SCF表達(dá)水平與一般臨床指標(biāo)、疾病活動(dòng)指標(biāo)、腎臟病理指標(biāo)的相關(guān)性。結(jié)果:各組患者性別、年齡間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。LN組血清SCF水平(332.87±56.37)ng/L顯著高于健康對(duì)照組(154.06±22.49)ng/L(P(27)0.01)。狼瘡活動(dòng)組SCF水平(357.29±63.85)ng/L顯著高于狼瘡穩(wěn)定組(310.03±40.17)ng/L(P(27)0.01)。Ⅲ型、Ⅳ型LN組的SCF水平分別明顯高于Ⅱ型、Ⅴ型LN組(c2=45.38,P(27)0.05)。難治狼瘡組在規(guī)范治療前的SCF水平(357.29±63.85)ng/L明顯高于治療敏感組(310.03±40.17)ng/L(t=2.633,P(27)0.05)。LN組血清SCF水平與UTP、抗ds-DNA定量、ANA滴度、SLEDAI積分、AI指數(shù)、TIL積分呈正相關(guān)(r=0.297,r=0.353,r=0.285,r=0.469,r=0.390,r=0.317,P均(27)0.05);與補(bǔ)體C3、補(bǔ)體C4呈負(fù)相關(guān)(r=-0.321,r=-0.361,P(27)0.05);與血清肌酐水平(Scr)、e GFR、CI指數(shù)無(wú)相關(guān)性(r=0.213,r=-0.144,r=-0.181,P0.05)。結(jié)論:1.LN患者的血清SCF水平高于健康人,提示著SCF可能參與了LN的發(fā)生發(fā)展過(guò)程。2.狼瘡活動(dòng)組的血清SCF水平明顯高于狼瘡穩(wěn)定組,且LN患者血清SCF水平與LN的臨床活動(dòng)指標(biāo)、腎臟病理活動(dòng)指標(biāo)有一定的相關(guān)性,提示著血清SCF水平可作為判斷LN疾病活動(dòng)的血清學(xué)監(jiān)測(cè)指標(biāo)之一。3.Ⅲ型、Ⅳ型LN組的SCF水平分別明顯高于Ⅱ型、Ⅴ型LN組,提示著血清SCF水平可能與LN的腎臟病理類型、病理增殖的程度有一定的關(guān)系。4.難治狼瘡組的血清SCF水平明顯高于治療敏感組,提示血清SCF表達(dá)水平對(duì)狼瘡性腎炎預(yù)后的判斷具有一定的預(yù)測(cè)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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R593.242
本文編號(hào)：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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R593.242
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