可溶性fractalkine与神经精神性狼疮的相关性

Correlation between soluble fractalkine and neuropsychiatric systemic lupus erythematosus

目的探讨可溶性fractalkine(sFKN)在神经精神性狼疮(NPSLE)中的作用。方法采集30例NPSLE患者(病例组)治疗前、后的血清和脑脊液(CSF),53例无神经精神症状的系统性红斑狼疮患者(SLE对照组)、39名健康者(健康对照组)的血清,17例无神经精神病变的结缔组织病(noNP-CTD组)、28例排除神经系统炎症的非结缔组织病(非CTD组)的CSF,将病例组分为弥漫性NPSLE(DNPSLE亚组)和局灶性NPSLE(FNPSLE亚组),采用酶联免疫吸附试验(ELISA)检测上述标本中的sFKN水平。结果DNPSLE亚组的血清及CSFsFKN均显著高于FNPSLE亚组(P值均<0.01);DNPSLE亚组的CSFIgG显著高于FNPSLE亚组(P<0.01),病例组和SLE对照组的血清sFKN水平均显著高于健康对照组(P值均<0.01)。DNPSLE亚组的CSFsFKN水平显著高于noNP-CTD组和非CTD组(P值均<0.01),而FNPSLE亚组与noNP-CTD组和非CTD组的差异无统计学意义(P值均>0.05)。病例组治疗后的血清及CSFsFKN水平较治疗前显著下降(P值分别<0.01、0.05)。病例组和SLE对照组中所有患者的血清sFKN水平与SLEDAI积分呈正相关(r=0.671,P<0.01)。病例组CSFsFKN水平与IgG水平呈正相关(r=0.945,P<0.01)。结论sFKN在系统性红斑狼疮的发病中发挥了一定作用,可作为系统性红斑狼疮疾病活动程度的一个指标。检测NPSLE患者血清及CSF的sFKN有助于判断病情严重程度,从而指导NPSLE的诊断和治疗。

Objective To investigate the role of soluble fractalkine （sFKN） in neuropsychiatric systemic lupus erythematosus （NPSLE）. Methods The sera and cerebrospinal fluid （CSF） of 30 patients with NPSLE were collected before and after treatment with 200-1 000 mg methylprednisolone （MP）. Patients with NPSLE were divided into diffuse NPSLE （DNPSLE） and focal NPSLE （FNPSLE） groups. Control group included serum samples from 53 SLE patients without any neuropsychiatric involvement （SLE controls） and 39 healthy volunteers, and CSF samples from 17 rheumatisants without neuropsychiatric involvement （noNP-CTD, including 10 SLE） and 28 patients without inflammation of nervous system or not diagnosed rheumatism （noCTD）. Levels of sFkn in the serum and CSF were measured by enzyme linked immunosorbent assay （ELISA）. Disease activity of SLE was assessed using the SLE Disease Activity Index （SLEDAI）. Results Serum and CSF levels of sFKN in DNPSLE group were significantly higher than those in FNPSLE group （both P〈0.01）, and CSF level of IgG in DNPSLE group was higher than that in FNPSLE group（P〈0.01）. Serum sFKN levels were significantly higher in patients with NPSLE or SLE controls than in healthy volunteers （both P〈0. 01）. CSF sFKN levels were significantly higher in patients with DNPSLE than those in patients with noNP-CTD or noCTD （both P〈0.01）, but there was no significant difference between FNPSLE and the controls （both P〈0.05）. Treatment reduced both serum （P〈0.01） and CSF （P〈0.05） levels of sFkn in patients with NPSLE.There was significant correlation between serum sFkn levels and the SLEDAI in patients with SLE （r=0. 671, P〈0.01）. CSF levels of sFkn were significantly correlated with levels of IgG in CSF in patients with NPSLE （r=0. 945, P〈0.01）. Conclusion Soluble FKN may play an important role in the pathogenesis of SLE and may serve as an indicator for the disease activity of SLE; measurement of sFKN in serum and CSF may be useful for the diagnosis and treatment of NPSLE and for the assessment of the severity of this disease.