摘要
目的:探讨系统性红斑狼疮(SLE)患者妊娠期外周血中滤泡辅助性T淋巴细胞(Tfh)的变化,并阐明Tfh细胞在妊娠期SLE患者中的免疫作用。方法:选取来自山东省青岛市市立医院和青岛市妇女儿童医院就诊的SLE患者,分为SLE妊娠组32例和SLE未妊娠组30例,以健康妊娠组(健康妊娠妇女)30例和健康未妊娠组(健康未妊娠妇女)25例为对照,SLE妊娠组32例患者(随访丢失2例)根据妊娠期间和终止妊娠后3个月内病情变化分为SLE妊娠预后不良组(8例)和SLE妊娠临床稳定组(22例),收集各组受试者临床资料和实验室检查指标。采用流式细胞术检测各组受试者外周血中CD4+诱导性T细胞共刺激因子(ICOS)+趋化因子C-X-C-基元受体5(CXCR5)+Tfh细胞占CD4+T淋巴细胞百分率(Tfh细胞百分率),采用Spearman相关分析检验SLE妊娠组患者外周血中Tfh细胞百分率与患者实验室检查指标的相关性,采用酶联免疫吸附试验(ELISA)法检测各组受试者外周血中白细胞介素6(IL-6)、白细胞介素21(IL-21)和干扰素γ(IFN-γ)水平。结果:与健康妊娠组比较,SLE妊娠组患者外周血中Tfh细胞百分率明显升高(P<0.01),健康未妊娠组受试者外周血中Tfh细胞百分率明显降低(P<0.05);与SLE未妊娠组比较,SLE妊娠组患者外周血中Tfh细胞百分率明显升高(P<0.05)。随访中,与SLE妊娠临床稳定组比较,SLE妊娠预后不良组患者外周血中Tfh细胞百分率明显升高(P<0.05)。SLE妊娠组患者外周血中Tfh细胞百分率与抗心磷脂抗体(ACA)-IgG和抗β2糖蛋白Ⅰ(β2GPⅠ)抗体滴度均呈正相关关系(r=0.7431,P<0.05;r=0.8307,P<0.01)。与健康妊娠组比较,SLE妊娠组患者外周血中IL-6和IL-21水平明显升高(P<0.05);与SLE未妊娠组比较,SLE妊娠组患者外周血中IL-21水平明显升高(P<0.05)。结论:SLE患者妊娠早期外周血中Tfh细胞百分率升高可能与SLE患者妊娠预后不良有关。
Objective:To investigate the changes of follicular helper T lymphocytes(Tfh)in peripheral blood of the patients with systemic lupus erythematosus(SLE)during pregnancy,and to clarify the immune effects of Tfh cells duing pregnancy.Methods:The SLE patients from Qingdao Municipal Hospital and Qingdao Women and Children Hospital were divided into SLE with pregnancy group(n=32)and SLE without pregnancy group(n=30);at the same time,healthy pregnancy group(healthy pregnancy women,n=30)and healthy non-pregnancy group(healthy non-pregnancy women,n=25)were used as control.According to the changes of lupus during pregnancy and after termination of pregnancy within 3 months,the 32 cases of SLE patients in SLE with pregnancy group(2 cases were lost during follow-up)were divided into poor prognosis group(n=8)and clinical stabilization group(n=22).The clinical data and laboratory examination indexes of the patients were collected.The percentages of CD4+inducible T-cell costimulatory factor(ICOS)+chemokine C-X-C-motif receptor 5(CXCR5)+Tfh cells in the CD4+T lymphocytes in peripheral blood of the patients in various groups(percentages of Tfh cells)were detected by flow cytometry.The relationships between the percentages of Tfh cells in peripheral blood of the patients in SLE with pregnancy group and the laboratory examination indexes were analyzed by Spearman correlation analysis.The levels of interleukin-6(IL-6),interleukin-21(IL-21)and interferon-γ(IFN-γ)in peripheral blood of the subjects in various groups were detected by enzyme linked immunosorbent assay(ELISA)method.Results:Compared with healthy pregnancy group,the percentage of Tfh cells in peripheral blood of the patients in SLE with pregnancy group was significantly increased(P<0.01),and the percentage of Tfh cells in peripheral blood of the subjects in healthy non-pregnancy group was significantly decreased(P<0.05).Compared with SLE without pregnancy group,the percentage of Tfh cells in peripheral blood of the patients in SLE with pregnancy group was significantly increased(P<0.05).During the follow-up,compared with clinical stabilization group,the percentage of Tfh cells in peripheral blood of the patients in poor prognosis group was significantly increased(P<0.05).The percentage of Tfh cells in peripheral blood of the patients in SLE with pregnancy group was positively correlated with the levels of anticardiolipin antibody(ACA)and anti-β2 glycoproteinⅠ(β2GPⅠ)antibody(r=0.7431,P<0.05;r=0.8307,P<0.01).Compared with healthy pregnancy group,the levels of IL-6 and IL-21 in peripheral blood of the patients in SLE with pregnancy group were significantly increased(P<0.05);compared with SLE without pregnancy group,the level of IL-21 in peripheral blood of the patients in SLE with pregnancy group was significantly increased(P<0.05).Conclusion:The increase of the percentage of Tfh cells in peripheral blood of the patients with SLE in early pregnancy may be related to the poor pregnancy prognosis in the patients with SLE.
作者
白杨
杨晨曦
刘小强
刘羽
邢倩
BAI Yang;YANG Chenxi;LIU Xiaoqiang;LIU Yu;XING Qian(Department of Rheumatology,College of Clinical Medical Sciences,Weifang Medical College,Shandong Province,Weifang 261000,China;Department of Reproductive Medicine,Qingdao Women and Children Hospital,Shandong Province,Qingdao 266000,China;Department of Obstetrics,Qingdao Women and Children Hospital,Shandong Province,Qingdao 266000,China;Department of Rheumatology,Qingdao Municipal Hospital,Shandong Province,Qingdao 266000,China)
出处
《吉林大学学报（医学版）》
CAS
CSCD
北大核心
2023年第1期166-172,共7页
Journal of Jilin University：Medicine Edition
基金
山东省卫健委计划项目(2019WS147)。
关键词
滤泡辅助性T淋巴细胞
系统性红斑狼疮
妊娠
预后
Follicular helper T lymphocytes
Systemic lupus erythematosus
Pregnancy
Prognosis
