系统性红斑狼疮患者血清GM-CSF及其抗体的变化及意义

The Significance of Serum Levels of GM-CSF and GM-CSF Ab in Patients with Systemic Lupus Erythematosus

目的:探讨人重组粒细胞-巨噬细胞集落刺激因子(GM-CSF)和GM-CSF抗体(GM-CSF Ab)水平在系统性红斑狼疮(SLE)发病中尤其是导致血液学损害发生的可能作用机制。方法:①用酶联免疫吸附法(ELISA)测定40例SLE(SLE组,按白细胞计数又分为白细胞减少组20例,白细胞正常组20例)、11例其他结缔组织病(病例对照组)及20例健康体检者(健康对照组)血清GM-CSF和GM-CSF Ab的水平;②按SLEDAI评分将SLE组分为活动期组16例,非活动期组24例,用ELISA测定两组血清GM-CSF和GM-CSF Ab的水平;③将SLE组治疗足10个月者12例用ELISA测定血清GM-CSF和GM-CSF Ab的水平进行治疗前后配对比较。④分析SLE组血清GM-CSF及GM-CSF Ab水平与临床指标(SLEDAI评分、血白细胞计数)的相关性。结果:①白细胞减少组血清GM-CSF及GM-CSF Ab水平高于白细胞正常组、病例对照组和正常对照组(P<0.05),白细胞正常组血清GM-CSF及GM-CSF Ab水平也高于疾病对照组和正常对照组(P<0.05);②活动期组血清GM-CSF及GM-CSF Ab水平高于非活动期组(P<0.05);③12例完成治疗的SLE患者治疗后血清GM-CSF及GM-CSF Ab水平低于治疗前(P<0.05);④SLE组血清GM-CSF及GM-CSF Ab水平与SLEDAI评分呈显著正相关(P<0.01),与SLE血白细胞计数呈显著负相关(P<0.05)。结论:血清GM-CSF及GM-CSF Ab水平与SLE,尤其与合并血液学损害的SLE患者疾病活动性有关,可能用来作为合并血液学损害的SLE患者的生物治疗靶点。

ObjectiVe： To study the possible roles of GM-CSF and GM-CSF Ab in the pathogenesis of systemic lupus erythematosus （SLE） ,especially with blood injury. Methods：（1）The serum levels of GM-CSF and GM-CSF Ab were assayed in 40 patients with SLE（ We divided 40 SLE patients according to the white blood cell count into 2 groups,one group of 20 people with normal white blood cell count and the other of 20 with decreased WBC） , 11 patients with other CTD（ disease controls）and 20 healthy controls were also assayed by ELISA. （2） We divided 40 SLE patients into 2 groups according to SLEDAI, active group with 16 people, negative groups with 24 people. The serum levels of GM-CSF and GM-CSF Ab were assayed by ELISA. （3）We also analyzed and compared the data and results of the serum levels of GM-CSF and GM-CSF Ab of 12 patients in therapy for over 10 months. （4） The dependablity of the serum GM-CSF and GM-CSFAb＇s levels of SLE group and clinical target （SLEDAI score,white blood cell count） were analyzed. Results：（1）The serum levels of GM-CSF and GM-CSF Ab were significantly higher in SLE patients in the group of the decreased white blood cell count than that of the normal white blood cell count in SLE group, disease controls and normal controls（ P 〈 0. 05 ）. The serum levels of GM-CSF and GM-CSF Ab were significantly higher in SLE patients with normal white blood cell count than that of the disease controls and normal controls（ P 〈0. 05 ）. （2）The serum level of GM-CSF and GM-CSF Ab had negative correlation with the levels of white blood cell eount（P 〈0. 05）. （3）The serum levels of GM-CSF and GM-CSF Ab of the 12 patients after therapy were lower than that before therapy（ P 〈 0.05 ）. （4）There was correlation between serum levels of GM-CSF and GM-CSF Ab,the level of disease activity in SLE group and SLEDAI （ P 〈0. 01 ） ,but no correlation with SLE white blood cell count（ P 〈 0. 05）. Conclusion：The measurement of serum GM-CSF and GM-CSF Ab may be used as indicators in SLE disease activities. GM-CSF and GM-CSF Ab may be the targets of hiotherapy in SLE patients with blood injury.