白塞病血循環(huán)內(nèi)皮微粒的檢測及臨床意義分析
發(fā)布時間：2018-10-23 18:51
【摘要】：目的:白塞病(Behcet’s disease,BD)白塞病是一種病因不明、多系統(tǒng)受累的炎癥性疾病,其疾病特點是復(fù)發(fā)性眼炎,口腔及生殖器潰瘍,皮膚損害,也可有多系統(tǒng)受累,包括胃腸道、血管、神經(jīng)系統(tǒng)等。BD多累及20~40歲青壯年,自然病程呈現(xiàn)緩解與復(fù)發(fā)交替出現(xiàn),遷延反復(fù),病情嚴(yán)重者可導(dǎo)致失明、心血管及中樞神經(jīng)系統(tǒng)嚴(yán)重病變,常給患者帶來巨大的精神壓力和經(jīng)濟(jì)負(fù)擔(dān)。雖然目前疾病發(fā)病機(jī)制仍不清楚,目前認(rèn)為其發(fā)病機(jī)制可能與宿主遺傳易感性與易感環(huán)境相互作用相關(guān)。多數(shù)學(xué)者認(rèn)為BD是一種多系統(tǒng)受累的血管炎性疾病,其組織病理學(xué)特點是血管周圍白細(xì)胞聚集增加,白細(xì)胞外滲到組織的程度取決于血管內(nèi)皮細(xì)胞的完整性及表面表達(dá)的粘附分子。大量研究顯示內(nèi)皮功能障礙是血管病變的始動因素,內(nèi)皮功能損傷為其血管炎發(fā)病機(jī)制之一。目前無論BD分類標(biāo)準(zhǔn),還是其活動度評估均以臨床評估為主,均缺乏特異的客觀評估指標(biāo)。因此,尋找一種能評估BD疾病活動度及預(yù)測該疾病嚴(yán)重程度的指標(biāo)刻不容緩。內(nèi)皮微粒(Endothelial cell-derived microparticles,EMPs)是一種內(nèi)皮細(xì)胞激活或凋亡時釋放的一種復(fù)雜的囊泡樣結(jié)構(gòu)。EMP不僅可以反映內(nèi)細(xì)胞的激活或損傷狀態(tài),而且可以調(diào)節(jié)炎癥反應(yīng)、凝血和血管功能。血漿中EMPs水平是新近發(fā)展的一種評估內(nèi)皮功能損傷的方法。因此,本研究集中探討EMPs是否可作為評估白塞病系統(tǒng)受累情況及其疾病活動度新的指標(biāo)。方法:本研究共納入39例滿足1990年白塞病國際診斷標(biāo)準(zhǔn)或2013年國際白塞病研究組發(fā)布了最新的白塞病國際標(biāo)準(zhǔn)和30例性別和年齡相匹配的健康者作為對照組。采用流式細(xì)胞儀檢測血漿中CD31+/CD42b-內(nèi)皮微粒水平。采用白塞病疾病活動窗(Behcet’s disease current activity form,BDCAF)和入組時伯明翰血管炎活動評分系統(tǒng)(Birmingham Vasculitis Activity Score,BVAS)對BD患者病情活動度進(jìn)行評估。結(jié)果:BD患者血漿EMPs水平明顯高于健康對照組(p=0.000)。BD患者血漿EMPs水平與BDCAF呈正相關(guān)(r=0.802,p=0.000),與BVAS呈正相關(guān)(r=0.607,p=0.000)有血管受累BD患者血漿EMPs水平較無血管受累患者顯著升高(p=0.000)。有消化道受累BD患者血漿EMPs水平較無消化道受累患者顯著升高,差異有統(tǒng)計學(xué)意義(p=0.011)。BD患者血漿EMPs水平在性別、皮疹、神經(jīng)系統(tǒng)受累、眼炎、關(guān)節(jié)癥狀及針刺試驗是否陽性之間無顯著差異。結(jié)論:BD患者血漿EMP水平明顯高于健康對照組,且與疾病活動度相關(guān),提示上述指標(biāo)可能成為預(yù)測BD疾病活動度新的指標(biāo);BD患者血漿EMPs水平升高,提示血管和消化道受累風(fēng)險增加。
[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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R597.9
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