青光眼睫状体炎综合征患者血液中补体系统活化状态的分析

Activation of serum complement in Posner-Schlossman syndrome patients

背景补体系统的活化参与葡萄膜炎和开角型青光眼的病理过程。青光眼睫状体炎综合征（PSS）的发病具有葡萄膜炎和开角型青光眼的病理特点，其具体病因及其与血清补体水平和活化情况的关系鲜见报道。目的检测PSS患者发病时血液中补体活化情况，为探讨PSS的发病机制提供依据。方法采用前瞻性病例对照研究方法，纳入2013年12月至2015年12月在深圳市眼科医院确诊的PSS患者79例为PSS组，同期纳入深圳市血液中心健康献血者83名为正常对照组。采用免疫散射比浊法检测2个组受检者血清补体途径中共同的活化成分c3、经典途径及凝集素途径中共同的活化成分C4、IgG、IgM及IgA的质量浓度；采用ELISA双抗夹心法测定各组受检者血清经典途径标志物补体c1q、凝集素途径标志物纤维胶凝蛋白2（FCN2）、替代途径标志物补体Bb因子、3条补体活化途径中的共同活化产物C3a及终末期溶解型膜攻击复合物sC5b一9的质量浓度；同时分析PSS组患者血清C3a与sC5b-9质量浓度变化的关系。结果PSS组患者血清c3、c4、C1q、FCN2、C3a、sC5b-9、IgG、IgM和IgA质量浓度明显高于正常对照组，差异均有统计学意义（Z=-4．743、-2．913、-1．985、-2．620、-2．062、-2．500、-7．010、-6．327、-3．652，均P〈0．05）；PSS组患者血清补体Bb因子质量浓度为13．87（9．24，32．00）μg／ml，明显低于正常对照组的20．51（12．90，33．50）μg／ml，差异有统计学意义（Z=-2．515，P=0．012）。PSS组患者血清sC5b-9质量浓度为0．41（0．16，1．32）μg／ml，血清C3a质量浓度为190．3（81．0，541．3）μg／ml，二者变化呈明显正相关（rs=0．832，P〈0．001）。结论PSS患者活动期补体系统活化，可能是通过补体替代途径和／或经典途径及凝集素途径实现的。

Background Activation of serum complement system is involved in the pathological process of uveitis and open angle glaucoma. Pathogenesis and pathological characteristics of Posner-Schlossman syndrome （PSS） are similar to uveitis and open angle glaucoma. However, etiology of PSS remains unelucidated. The activation complement in PSS patients＇ serum is rarely reported. Objective The aim of this study was to investigate the activation of serum complement in PSS patients for PSS pathogenesis. Methods A prospective case-controlled study was designed. The peripheral blood simples of 79 PSS patients were collected from Shenzhen Eye Hospital during December 2013 to December 2015,and the peripheral blood simples were obtained from 83 unrelated healthy blood donors as healthy control group. Immuno-scatter turbidmetry was adopted to detect the common activated components in complement pathway in each group including complement C3 （a vital intersection molecule in the three pathways）,C4 （the vital molecule both the complement classical and lectin pathways）, split products C3a, soluble membrane attack complex （ sCSb-9 ） , C1q （ complement classical pathway） , L-ficolin （ complement lectin pathway） , complement factor Bb （complement alternative pathway） ,IgG,IgA and IgM. The correlation between serum C3a content and sCSb-9 content in PSS group was analyzed. The serum contents of fabric binding protein 2 （FCN2） （ a marker of serum classical pathway）, factor Bb （a marker of complement alternative pathway）, C3a （the common activation products of three complement activation pathways）, and sCSh-9 were assayed by ELISA. This research protocal wasapproved by Shenzhen Eye Hospital and written informed consent was obtained from each PSS patient prior to any medical examination. Results Compared with normal control group, the serum levels of C3, C4, C3a, sC5b-9, C1 q, FCN2 ,IgG,IgA and IgM were significantly higher in PSS group （ Z = -4. 743, -2. 913, - l. 985, -2. 620, -2. 062, -2. 500,- 7. 010, - 6. 327, - 3. 652, all at P 〈0. 05 ）. The serum complement factor Bb level was 13.87 （ 9.24, 32.00） μg/ml in PSS group ,which was significantly lower than 20.51 （12.90,33.50） μg/ml in normal control group （Z =-2.515,P = 0. 012 ）. Serum C3a content was positively correlated with the serum s C5b-9 content in PSS group （ r = 0, 832,P〈0. 001 ）. Conclusions The serum complement system is activated in PSS patients. Complement alternative pathway,classical pathway and lectin pathway might all be involved in the activative process of complement system.