三种风湿性疾病血清反应物和细胞因子水平对评估病情活动性的意义

Significance of serum reactants and cytokine level of three kinds of rheumatic diseases in evaluating the activity of the disease

目的:探讨风湿病患者血清急性期反应蛋白-C反应蛋白(C-reactiveprotein,CRP)水平与其产生的主要诱导物-白细胞介素6(interleukin6,IL-6)及其可溶性受体(solublereceptor,sIL-6R)的相关性以及对疾病活动性的评估价值。方法:利用免疫比浊法和ELISA法分别对23例系统性红斑狼疮(systemiclupuserythematosus,SLE)、25例类风湿关节炎(rheumatoidarthritis,RA)和28例强直性脊柱炎(ankylosingspondylitis,AS)患者的血清CRP、IL-6及其可溶性受体的水平进行了检测,比较上述指标对疾病活动性的评估价值。结果:SLE患者血清sIL-6R水平最高犤(47.28±27.61)×103g/L犦,RA患者次之犤(28.19±14.98)×103g/L犦,AS最低犤(17.47±9.91)×103g/L犦,SLE与AS、RA比较,RA与AS比较,差异均有显著性意义(P<0.05～0.001);血清sIL-6R/IL-6比值SLE患者最高(175.14±125.75),RA次之(124.12±74.78),AS最低(51.33±39.71),SLE与RA、AS比较,差异有显著性意义(P<0.05～0.001)。血清CRP水平与sIL-6R/IL-6比值呈负相关(r=-0.68)。结论:CRP可作为判断AS和RA疾病活动的指标之一。而SLE患者弱急性期蛋白反应可能与高水平血清sIL-6R、高sIL-6R/IL6比值、以Th2淋巴细胞反应为主的炎症反应类型以及大剂量、持续的糖皮质激素的应用有关。

AIM:To investigate the relationship between serum acute phase reactive protein-C reactive protein(CRP) and its main inducer-interleukin 6(IL-6) and its soluble receptor(sIL-6R),and study their validities in evaluating the activity of rheumatoid diseases.METHODS:The serum levels of CRP,IL-6,sIL-6R were measured with turbidimetry and ELISA respectively in 23 patients with systemic lupus erythematosus(SLE),25 patients with rheumatoid arthritis(RA) and 28 patients with ankylosing spondylitis(AS),and the validities of the above-mentioned indexes in evaluating the activity of these three diseases were compared.RESULTS:The serum level of sIL-6R was the highest in the SLE patients[(47.28±27.61)×103 g/L],followed by those in the RA patients[(28.19±14.98)×103 g/L] and the lowest in the AS patients[(17.47 ±9.91)×103 g/L],that of the SLE patients was significantly different from those of the AS and RA patients,and there was also significant difference between the RA and AS patients (P< 0.05 to 0.01).The ratio of sIL-6R to IL-6 was was the highest in the SLE patients(175.14±125.75),followed by those in the RA patients(124.12±74.78) and the lowest in the AS patients(51.33±39.71),that of the SLE patients were significantly different from those of the RA and AS patients(P< 0.05 to 0.001).The serum level of CRP was negatively correlated with the ratio of sIL-6R to IL-6(r=-0.68).CONCLUSION:CRP can be the one of the indicators in evaluating the activity of RA and AS.The weak acute-phase protein response in SLE patients may be contributed to the high serum level of sIL-6R,high the sIL-6R/IL-6 ratio,the inflammatory process of Th2 lymphocytes response and the high dose,lasting taking of glucocorticoid.