血浆置换对系统性红斑狼疮患者外周血中高迁移率族蛋白-1水平的影响

Effects of plasmapheresis on serum levels of HMGB1 in patients with systemic lupus erythematosus

目的探讨血浆置换(Plasmapheresis)对系统性红斑狼疮(systemic lupus erythematosus,SLE)患者外周血高迁移率族蛋白-l(highmobility group box chromosomal protein l,HMGBl)、肿瘤坏死因子-α(tu-mornecrosis factor-α,TNF-α)等炎症介质水平的影响,同时观察血浆置换对患者临床症状及预后的影响。方法随机选取2008～2010年收治于山东大学附属省立医院肾内科的重症狼疮患者22例,依据1997年修订的SLE分类标准的诊断标准,在糖皮质激素及其冲击疗法基础上给予血浆置换。分别留取血浆置换治疗前(T0)、治疗开始后2 h(T1)及血浆置换停止后12 h(T2)各时间点的右侧桡动脉血标本5 mL,高速离心后取血清-20℃保存,采用ELSIA方法检测动脉血清的HMGB1浓度,放射免疫法检测其中TNF-α的浓度。结果患者血浆置换前血清的HMGB-l浓度为(6.924±2.832)ng/mL,血浆置换2 h为(4.166±2.172)ng/mL,下降到最低,血浆置换停止后12 h稍有回升,为(4.872±2.098)ng/mL,仍低于血浆置换前浓度,差异均有统计学意义(P<0.05)。血浆置换前血清中的TNF-α浓度为(81.11±14.06)pg/mL,血浆置换2 h为(50.46±12.99)ng/mL,血浆置换停止后12 h稍有回升,为(61.87±14.09)ng/mL,仍低于血浆置换前,差异均有统计学意义(P<0.05)。结论血浆置换可显著降低系统性红斑狼疮患者外周血中HMGB-1及TNF-α浓度,有利于控制患者病情恶化,为进一步应用免疫抑制剂治疗争取时间。

【Objectives】 To evaluate the effects of plasmapheresis on serum levels of HMGB1 and TNF-α in patients with SLE,and of its clinical and prognostic effects on these patients.【Methods】 22 patients with severe SLE were admitted to Department of Nephropathy of Provincial Hospital affiliated to Shandong University,including 6 males and 16 females,with（30.6 ± 5.45） years of average age and 0.25 to 9 years course of disease.According to 1997 Revised Criteria for Classification of SLE,these patients were treated with glucocorticoid and corticosteroid,on basis of which plasma exchange therapy was performed.Vascular access for the treatment was percutaneously via the internal jugular or right femoral vein using a double lumen（dialysis） catheter.Blood samples for determination of HMGB1 and TNF-α concentrations from these patients were collected before plasmuplercsis,during（2 hours after initiation） and 12 hours after plasmapheresis.Respectively,the supernatant was taken and stored at-20℃ after high speed centrifugation at 4 000 r/pm for 5 minutes.Concentrations of HMGB1 were assessed by ELISA and TNF-α by radioimmunoassay.【Results】 Concentrations of HMGB1 of patients before plasmapheresis averaged（6.924 ± 2.832） ng/mL,（4.166 ± 2.172） ng/mL 2 hours after the initiation and slightly rose to（4.872 ± 2.098） ng/mL 12 hours after the treatment（P ＆lt;0.05）.Similarly,levels of TNF-α dropped to（50.46 ± 12.99） pg/mL 2 hours after the initiation compared with the average levels（81.11 ± 14.06） pg/mL before the treatment,and a significant increase to（61.87 ± 14.09） ng/mL was also observed 12 hours after plasmapheresis（P ＆lt;0.05）.【Conclusion】 Plasmapheresis treatment significantly reduced serum levels of HMGB1 and TNF-α in patients with SLE,suggesting a positive and beneficial effect on the disease progression and prognosis.