环磷酰胺对儿童系统性红斑狼疮患者外周血淋巴细胞亚群变化的影响

Effects of cyclophosphamide on changes of lymphocyte subsets in peripheral blood of children patients with systematic lupus erythematosus

目的:探讨环磷酰胺对儿童系统性红斑狼疮(SLE)患者外周血淋巴细胞亚群变化的影响,为治疗儿童SLE提供依据。方法:选取30例儿童SLE患者和30例健康儿童,检测其外周血T细胞、B细胞、自然杀伤(NK)细胞和自然杀伤T(NKT)细胞水平。将SLE患者分为单纯激素治疗组和环磷酰胺联合激素治疗组,每组各15例,采用流式细胞术检测2组治疗前后儿童外周血淋巴细胞亚群比率的变化。结果:与健康对照组比较,SLE患儿组CD3+CD4+Th细胞比率明显降低(P<0.05);CD3+CD8+Tc细胞比率明显升高(P<0.05);CD3-(CD16CD56)+NK和CD3+(CD16CD56)+NKT细胞比率明显降低(P<0.05),而CD3-CD19+B细胞比率明显增高(P<0.01)。儿童SLE患者外周血CD3+CD8+Tc细胞比率与SLE活动指数(SLE DAI)呈正相关关系(r=0.754 7,P<0.01);CD3-CD19+B细胞比率与SLEDAI亦呈明显的正相关关系(r=0.158 6,P=0.029 3);Th、NK和NKT细胞比率与SLE DAI无明显相关性(P>0.05)。与治疗前比较,单用激素治疗组患者治疗后B细胞比率明显降低(P<0.05);NK、NKT和Th细胞比率均有所升高,Tc细胞比率降低但差异无统计学意义(P>0.05)。环磷酰胺联合激素组治疗后患者B细胞比率较治疗前明显降低(P<0.01),NK细胞、Th细胞比率较治疗前明显升高(均P<0.01)。结论:儿童SLE患者淋巴细胞亚群比例的失调与SLE的发病有关,环磷酰胺联合激素治疗儿童SLE效果较好。

Objective To explore the effect of cyclophosphamide on changes of lymphocyte subsets in peripheral blood of children patients with systematic lupus erythematosus（SLE） and to provide evidence for curing children with SLE.Methods 30 children with SLE and 30 healthy children were selected.The levels of T cells,B cells,NK cells and NKT cells in peripheral blood were detected.The SLE patients were randomly divided into hormone therapy group（n=15） and cyclophosphamide combined with hormone therapy group（n=15）,the changes of the levels of lymphocyte subsets in peripheral blood before and after treatment were detected by flow cytometry.Results Compared with healthy control group,the ratio of CD3＋CD4＋ Th cells in SLE patient group was decreased obviously（P0.05）;the ratio of CD3＋CD8＋ Tc cells was markedly increased（P0.05）;the ratios of CD3-（CD16CD56）＋NK and CD3＋（CD16CD56）＋NKT cells were decreased obviously（P0.05）;the ratio of CD3-CD19＋ B cells was markedly increased（P0.01）.The ratio of CD3＋CD8＋ Tc cells in peripheral blood of children with SLE was positively related to SLE DAI（r=0.754 7,P0.01）;the ratio of CD3-CD19＋ B cells was also positively related to SLE DAI（r=0.158 6,P=0.029 3）.The ratios of Th,NK and NKT cells were not related to SLE DAI（P0.05）.Compared with before treatment,the ratio of CD3-CD19＋ B cells was significantly decreased after treatment in hormone therapy group（P0.05）,and the ratios of NK,NKT and Th cells were increased and the ratio of Tc cells was decreased,but there was no significant difference（P0.05）.In cyclophosphamide combined with hormone therapy group,the ratio of B cells was decreased after treatment,but the ratios of NK,NKT and Th cells were increased compared with before treatment（P0.01）.Conclusion The imbalanced proportion of lymphocyte subsets in the children with SLE is involved in the pathogenesis of SLE,and the treatment of cyclophosphamide combined with hormone is more effective.