幼年特发性关节炎和系统性红斑狼疮患儿的免疫特征

Immune Features of Juvenile Idiopathic Arthritis and Systemic lupus Erythematosus in Children

目的:分析幼年特发性关节炎(JIA)和系统性红斑狼疮(SLE)患儿细胞及体液免疫特征。方法:选择JIA患儿66例(JIA组)、SLE患儿50例(SLE组)及健康儿童50例(对照组),检测JIA组及SLE组儿童血常规(Hb、WBC、PLT)及CRP水平,比较3组儿童淋巴细胞亚群和免疫球蛋白及补体水平。结果:JIA组CRP及PLT升高率明显高于SLE组(P<0.05),JIA组CD4^+比例高于对照组(P<0.05),NK比例低于对照组(P<0.05),SLE组CD8^+高于对照组(P<0.05),NK比例低于对照组(P<0.05);JIA组IgG、IgM、lg A及C_3均高于对照组(P<0.05),SLE组IgG、IgM、lg A均高于对照组(P<0.05),C_3、C_4均低于对照组(P<0.05),SLE组C_3、C_4均低于JIA组(P<0.05);JIA组CD4^+与JADAS-27正相关(P<0.05),SLE组CD8^+与SLEDAI正相关(P<0.05),CD8^+在判断SLE疾病活动中的ROC曲线下面积达0.858。结论:SLE和JIAT均存在T细胞亚群失衡和B细胞异常活化以及NK细胞功能降低,但两种疾病在主导失衡的T细胞亚群、NK功能不足以及补体紊乱方面有明显的不同。

Objective： To investigate the cellular and humoral immune characteristics in children with juvenile idiopathic arthritis（ JIA） and systemic lupus erythematosus（ SLE）. Methods： 66 children（ JIA group）,50 children with SLE（ SLE group） and 50 healthy children（ control group） were selected. The blood routine（ Hb,WBC,PLT） and CRP levels of children in JIA group and SLE group were measured,and the lymphocyte subsets and immunoglobulin and complement levels were compared in the 3 groups. Results： The increase rate of Hb and PLT in JIA group was significantly higher than that in SLE group（ P〈0. 05）,andthe proportion of CD4~＋in JIA group was higher than that of the control group（ P〈0. 05）; the proportion of NK was lower than that of the control group（ P〈0. 05）; CD8~＋in SLE group was higher than that of the control group（ P〈0. 05）; CD8~＋and CD19~＋in SLE group were higher than that of JIA group（ P〈0. 05）; the proportion of NKin SLE group was lower than that of JIA group（ P〈0. 05）; IgG,IgM,lg A and C_3 in JIA group were higher than that of the control group（ P〈0. 05）; IgG,IgM and lg A in SLE group were higher than that of the control group（ P〈0. 05）,and C_3 and C_4 in SLE group were lower than that of the control group（ P〈0. 05）; C_3 and C_4 in SLE group were lower than that of JIA group（ P〈0. 05）. Positive correlation was between CD4~＋and JADAS-27 in JIA group（ P〈0. 05）,and positive correlation was between CD8~＋and SLEDAI in SLE group（ P〈0. 05）. CD8~＋is 0. 858 under the ROC curve of the SLE disease activity. Conclusion： SLE and JIAT are in the imbalance of T cell subsets,abnormal activation of B cells and the decrease of NK cell function,but the two diseases are significantly different in the leading disequilibrium of the T cell subgroup,the insufficiency of NK and the complement disorder.