抗内皮细胞抗体、细胞间黏附分子-1在狼疮肾炎中的临床意义

Clinial significance of antiendothelial cell antibody and intercellular adhesion molecule-1 in lupus nephritis

目的探讨IgG型抗内皮细胞抗体(IgG-AECA)、细胞间黏附分子-1(ICAM-1)在狼疮肾炎发病机制中的作用及临床意义。方法用间接免疫荧光法(IIF)检测39例活动期系统性红斑狼疮(SLE)患者及健康对照组的IgG-AECA阳性率;再将39例患者依据IgG-AECA分为阳性、阴性两组,用酶联免疫吸附法(ELISA)测定可溶性细胞间黏附分子-1(sICAM-1)在两组中的血清水平。同时依据临床症状及实验室指标将活动期患者分为狼疮肾炎组和非狼疮肾炎组,分别测定上述两组的IgG-AECA阳性率及sICAM-1血清水平。结果IgG-AECA的阳性率在SLE活动期组高于健康对照组,差异有显著性(P<0.05)。在SLE活动期患者中IgG-AECA阳性组的sICAM-1的血清水平高于IgG-AECA阴性组(P<0.05);有狼疮肾炎组IgG-AECA阳性率及sICAM-1的血清水平均高于无狼疮肾炎组(均P<0.05)。结论IgG-AECA可能通过上调血管内皮细胞的ICAM-1表达水平,吸引淋巴细胞黏附引起血管损害的机制,在SLE发病及疾病发展中起着重要作用。二者与狼疮肾炎活动密切相关,可将二者作为监测狼疮肾炎活动、评价疾病活动性、指导合理治疗的指标。

[ Objective] To investigate the clinical significance and the role in pathogenesis on IgG-antiendothelial cell antibody （IgG-AECA） and intercellular adhesion molecule-1 （ICAM-1） in lupus nephritis. [Methods] The serial positive rate of IgG-AECA in 39 patients with active SLE and healthy controls was detected by indirect immunofluorescence OIF） technique. 39 active patients with SLE were divided into two groups according serial positive or negative result of IgG-AECA, and the serial level of soluble intercellular adhesion molecule-1 （sICAM-1） was determined by an enzyme linked immunosorbent assay （ELISA） in two groups. At the same time, the active patients were divided into lupus nephritis and non-nephritis group by related clinical manifestations and laboratory markers, the positive rate of IgG-AECA and serial level of sICAM-1 were measured in these two groups respectively. [Resalts] The positive rate of IgG-AECA in active SLE group was higher than it in healthy control, there was significant difference between these two groups, P 〈0.05. The serial level of sICAM-1 in patients with positive IgG-AECA was higher than it in negative IgG-AECA patients in active SLE group, P 〈0.05. The positive rate of IgG-AECA and serial level of slCAM-1 in lupus nephritis group both was higher than that in non-nephritis group, P 〈0.05. [Conclusions] IgG-AECA maybe play an important role in the pathogenic, developmental process and vascular lesion of SLE by up-regulating the express of ICAM-1 on vascular endothelial cell （VEC） and mediating adhesion function between lymph-cell and VEC. There were closely eorrelation between those two markers and activity of lupus nephritis. IgG-AECA and sICAM-1 may sever as the markers for monitoring activity of lupus nephritis, evaluating activity of SLE and working out feasibility therapy plan.