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抗中性粒細胞胞漿抗體相關性小血管炎患者血清炎性因子與visfatin的表達

發(fā)布時間:2018-07-26 15:34
【摘要】:目的:(1)探討抗中性粒細胞胞漿抗體(ANCA)及其靶抗原蛋白酶3(PR3)和髓過氧化物酶(MPO)的檢測對ANCA相關性小血管炎(AASV)的應用價值;(2)觀察AASV患者在小血管炎癥活動期,血清炎性因子C反應蛋白(CRP)、白細胞介素6(IL-6)、腫瘤壞死因子(TNF-α)和內臟脂肪素(visfatin)的濃度變化及緩解期走向;(3)分析主要由內臟脂肪分泌的visfatin在AASV炎性損傷和免疫調控方面的作用,及其與CRP、IL-6、TNF-α間的潛在關聯(lián)。 方法:對52例AASV活動期與25例緩解期血清樣本采用間接免疫熒光法檢測ANCA,依據熒光顯微鏡下免疫熒光的著染部位不同分為胞漿型ANCA(cANCA)和核周型ANCA(pANCA);應用酶聯(lián)免疫吸附法測量PR3、MPO、 IL-6、TNF-α及visfatin;免疫比濁法測定CRP含量。 結果:(1) cANCA與pANCA各自識別對應的靶抗原PR3和MPO,具有靶抗原特異性(P0.001),且較長時間內不隨疾病的轉歸而改變(P0.05)。(2)AASV活動期CRP、IL-6、TNF-α、visfatin水平較正常對照組均升高(P0.001);活動期與緩解期比較CRP(P0.05)、IL-6(P0.001)含量不同程度下降;TNF-α沒有明顯降低(P0.05);而AASV緩解期visfatin含量較治療前仍繼續(xù)升高(P0.05)。緩解期與對照組比較CRP(P0.001)、TNF-α(P0.05)、visfatin(P0.001)仍有差異,但IL-6已接近正常對照組(P0.05)。(3) AASV患者各炎性因子間均呈正相關性,CRP與IL-6間的相關系數為0.471(P0.001), CRP與TNF-α間的相關系數為0.315(P0.05), CRP與visfatin間的相關系數為0.364(P0.01), IL-6與TNF-α司的相關系數性為0.458(P0.01), IL-6與visfatin間的相關系數為0.577(P0.001),TNF-α與visfatin間的相關系數為0.550(P0.001)。 結論:ANCA及其靶抗原PR3和MPO的檢測具有重要的疾病診斷價值,但由于其在體內濃度維持時間較長,不能用ANCA及其靶抗原水平來預知血管炎的活動性、治療效果、緩解和/或已經復發(fā)。數據顯示,AASV活動期與對照組比較,血清炎性因子CRP、IL-6、 TNF-α和visfatin濃度顯著升高,且各炎性因子和visfatin間存在正相關調控關系。在緩解期CRP、IL-6、出現(xiàn)不同程度的下調,而TNF-α含量回落不明顯,緩解期血清visfatin的含量較活動期仍有所升高,提示visfatin和TNF-α之間存在互為調控的劑量依賴關系,visfatin的這一變化可能也預示著AASV這一慢性消耗性疾病在維持緩解期內臟脂肪細胞的緩慢修復,對延長患者的中性粒細胞的生存時間起作用。
[Abstract]:Objective: (1) to investigate the value of detection of anti-neutrophil cytoplasmic antibody (ANCA) and its target antigen protease 3 (PR3) and myeloperoxidase (MPO) in (AASV) of ANCA associated vasculitis. The changes of serum inflammatory factor C reactive protein (CRP), interleukin 6 (IL-6), tumor necrosis factor 偽 (TNF- 偽) and visceral lipoprotein (visfatin) and the tendency of remission were analyzed. (3) the role of visfatin, mainly secreted by visceral fat, in the inflammatory injury and immune regulation of AASV was analyzed. And its potential association with CRP IL-6 TNF- 偽. Methods: the serum samples of 52 patients with active AASV and 25 patients with remission were detected by indirect immunofluorescence method. According to the location of immunofluorescence staining under fluorescence microscope, they were divided into cytoplasmic ANCA (cANCA) and perinuclear ANCA (pANCA); using enzyme-linked immunosorbent assay (Elisa). The levels of PR3 MPO, IL 6 TNF- 偽 and visfatin were measured by immunoturbidimetric method. The content of CRP was determined by immunoturbidimetric method. Results: (1) cANCA and pANCA recognized the corresponding target antigens PR3 and MPO respectively, which had target antigen specificity (P0.001), and did not change with the outcome of the disease for a long time (P0.05). (2). The level of AASV IL-6TNF- 偽 visfatin in active phase of AASV was higher than that in normal control group (P0.001). The content of CRP (P0.05) IL-6 (P0.001) did not decrease significantly (P0.05) in active phase and remission period (P0.05), while the content of visfatin in remission period of AASV was still higher than that before treatment (P0.05). The difference of CRP (P0.001) TNF- 偽 (P0.05) and visfatin (P0.001) between the remission stage and the control group was also found. But IL-6 was close to the normal control group (P0.05). (3). The correlation coefficient between AASV and IL-6 was 0.471 (P0. 001), CRP and TNF- 偽 was 0.315) (P0.05 between), CRP and visfatin was 0.364 (P0.01), and between IL-6 and TNF- 偽 was 0.364 (P0. 01). The correlation coefficient between IL-6 and TNF- 偽 was 0.471 (P0. 001) between), CRP and TNF- 偽 (P0. 05). The correlation coefficient between IL-6 and TNF- 偽 was 0.364 (P0. 01). The correlation coefficient between IL-6 and visfatin was 0.577 (P0.001) and the correlation coefficient between TNF- 偽 and visfatin was 0.550 (P0.001). Conclusion the detection of PR3 and MPO is of great value in the diagnosis of vasculitis. However, because of the long duration of concentration in vivo, the level of ANCA and its target antigen can not be used to predict the activity and therapeutic effect of vasculitis. Remission and / or recurrence. The data showed that the concentrations of serum inflammatory cytokines CRP- 6, TNF- 偽 and visfatin were significantly higher in the active period of AASV than in the control group, and there was a positive correlation between the inflammatory factors and visfatin. In the remission phase, the levels of serum visfatin were decreased in different degrees, but the content of TNF- 偽 was not significantly decreased, and the level of serum visfatin in the remission phase was still higher than that in the active phase. These results suggest that there is a dose-dependent relationship between visfatin and TNF- 偽, and this change of visfatin may also indicate the slow repair of visceral adipocytes in AASV, a chronic expendable disease, during the maintenance period of remission. It can prolong the survival time of neutrophils in patients.
【學位授予單位】:天津醫(yī)科大學
【學位級別】:碩士
【學位授予年份】:2012
【分類號】:R392

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