脐带间充质干细胞移植对不同证型系统性红斑狼疮患者的效果分析

Therapeutic effect of umbilical cord-derived mesenchymal stem cell transplantation in systemic lupus erythematosus patients with different patterns of syndromes

背景:系统性红斑狼疮按中医辨证分为热毒炽盛等4个症型,治疗以补肾养阴,清化淤毒为主,但仍有许多患者治疗效果不佳。间充质干细胞具有多向分化、造血支持和免疫调节的功能,目前已有多项研究用于治疗难治性、复发性系统性红斑狼疮,取得良好疗效。目的:探讨脐带间充质干细胞移植对不同证型系统性红斑狼疮患者的疗效。方法:系统性红斑狼疮患者21例,经中医辨证分成热毒炽盛证、肝肾阴虚证、脾肾阳虚证及气滞血瘀证4型,分别统计患者脐带间充质干细胞移植前后各型的临床及实验室指标变化。结果与结论:脐带间充质干细胞移植1,3,6个月均可有效减少系统性红斑狼疮患者实验尿蛋白含量,降低系统性红斑狼疮疾病活动指数评分(P<0.01)。与移植前比较,移植脐带间充质干细胞后1,3,6个月可显著减少肝肾阴虚型患者尿蛋白含量(P<0.01),移植后1,3个月对热毒炽盛及气滞血瘀型尿蛋白含量为轻度减少(P<0.05),脾肾阳虚型患者在植后1个月时的尿蛋白含量轻度减少(P<0.05)。脐带间充质干细胞移植可提高所有中医分型患者的血浆白蛋白含量(P<0.01),其中对热毒炽盛型效果稍差(P<0.05)。脐带间充质干细胞移植后各型患者外周血血小板有上升趋势,但与移植前相比差异无显著性意义。结果说明,脐带间充质干细胞移植治疗系统性红斑狼疮有效,对不同症型的系统性红斑狼疮患者的疗效有一定的差异。

BACKGROUND： Systemic lupus erythematosus（SLE） is classified into four types, and the major treatment is to tonify kidney and nourish yin, clear blood stasis and toxin by the traditional Chinese medicine（TCM）. Even though, there are still many patients with poor efficacy. Mesenchymal stem cells have the capacity of multiple differentiation, hematopoietic support and immune regulation, thus having been used for the treatment of refractory, recurrent SLE and achieving good effects.OBJECTIVE： To investigate the therapeutic effect of umbilical cord-derived mesenchymal stem cell transplantation on SLE patients with different patterns of syndromes. METHODS： Twenty-one SLE patients were clustered to four syndrome types of TCM, including heat-toxin, yin deficiency of liver and kidney, yang deficiency of spleen and kidney, and qi stagnation and blood stasis. The changes in clinical and laboratory indicators were analyzed statistically before and after cell transplantation. RESULTS AND CONCLUSION： The level of 24-hour proteinuria and SLE disease activity index scores in SLE patients were significantly decreased at 1, 3, 6 months after cell transplantation（P〈0.01）. Umbilical cord-derived mesenchymal stem cell transplantation could significantly reduce the 24-hour proteinuria in SLE patients with yin deficiency of liver and kidney at 1, 3 and 6 months（P〈0.01）, while slightly reduce the 24-hour proteinuria in SLE patients with heat-toxin and qi stagnation and blood stasis at 1, 3 months（P〈0.05） as well as in SLE patientswith yang deficiency of spleen and kidney at 1 month（P〈0.05）. Additionally, umbilical cord-derived mesenchymal stem cell transplantation could increase the serum albumin levels in all the SLE patients（P〈0.01）, although the changes in patients with heat-toxin were moderate（P〈0.05）. All the SLE patients of four types had an increasing trend of their platelet counting after cell transplantation, but there was no statistical difference before and after cell transplantation. Taken together, umbilical cord-derived mesenchymal stem cell transplantation is effective for treatment of SLE, but has different therapeutic efficacy on SLE patients with different syndrome types of TCM.