原发性干燥综合征90例血清C反应蛋白转化生长因子-β1水平变化及意义

Changes and significance of serum C-reactive protein and transforming growth factor-β1 levels in patients with primary Sjogren's syndrome

目的:探讨血清CRP、TGF-β1与pSS的联系。方法:选择90例pSS患者(观察组)及30名健康人群(对照组),观察组按病情严重不同分为重度17例、中度43例、轻度30例,观察组中未发生肺间质改变(ILD)54例、合并ILD 36例(其中Ⅰ期患者15例、Ⅱ期患者13例、Ⅲ期患者8例)。ELISA测定患者和健康人血清中CRP、TGF-β1水平,并探讨其和pSS严重程度及ILD不同分期的联系。统计方法使用方差分析,SNK-q检验或t检验,Spearman等级相关分析等。结果:观察组血清CRP、TGF-β1水平分别为[(13.5±7.8)mg/L],[(61±14)μg/L],高于对照组[(3.5±1.1)mg/L]和[(28±9)μg/L],差异有统计学意义(t=6.980,P<0.01;t=12.086,P<0.01)。在观察组内,病情中、重度的患者其血清CRP浓度分别为[(14.6±2.1)mg/L]和[(16.5±3.3)mg/L],比轻度患者[(11.3±3.2)mg/L]高,病情中、重度的患者其血清TGF-β1浓度分别为[(61±13)μg/L]和[(76±18)μg/L],比轻度患者[(51±14)μg/L]高,而且重度患者的水平提高的更显著(F=3.634,P<0.01;F=4.661,P<0.01);血清CRP、TGF-β1浓度和病情严重度呈正相关[r=0.786,P<0.01;r=0.516,P<0.01]。观察组内患者合并有ILD的患者,其血清CRP、TGF-β1浓度分别为[(15.5±3.2)mg/L]和[(74±19)μg/L],比无合并ILD的患者[(10.5±2.2)mg/L]和[(52±14)μg/L)]高(t=8.791,P<0.01;t=6.321,P<0.01)。观察组内,ILDⅡ、Ⅲ期的患者,其血清CRP浓度分别为[(16.3±8.2)mg/L]和[(19.1±10.1)mg/L],比Ⅰ期患者[(13.4±7.3)mg/L]高,TGF-β1浓度分别为[(74±19)μg/L]和[(85±21)μg/L],比Ⅰ期患者[(63±15)μg/L]高,Ⅲ期的患者水平高的更显著(F=4.640,P<0.01;F=5.673,P<0.01);pSS患者血清CRP、TGF-β1的浓度和ILD的分期都呈正相关关系(r=0.718,P<0.01;r=0.809,P<0.01)。结论:pSS患者血清CRP、TGF-β1浓度都较健康人升高,这2种因子很可能和pSS病情活动以及合并的ILD的转归有联系。

Objective To explore the relationship between serum C-reactive protein(CRP),transfor-ming growth factor-β1(TGF-β1)levels and patients with primary Sj?gren's syndrome(pSS).Methods Ninety patients with pSS(observation group)and 30 healthy people(control group)were recruited.The observation group was divided into 17 severe disease cases,43 moderate disease cases and 30 mild cases.In the observation group,54 cases were without lung interstitial change(ILD)and 36 cases were with ILD(including 15 in stageⅠ,13 in stageⅡand 8 in stageⅢ).The serum levels of CRP and TGF-β1 were measured by enzyme-linked immuno sorbent assay(ELISA),and the relationship between the levels of CRP,TGF-β1 and the severity of pSS and different stages of pulmonary interstitial disease was evaluated.Variance analysis,Student-Newman-Keuls(SNK)-q test or t test,Spearman rank correlation analysis were used for statistical analysis.Results The serum CRP level of the observation group and the control group were[(13.5±7.8)mg/L]and[(3.5±1.1)]mg/L,respec-tively.The serum TGF-β1 level of the observation group and the control group were[(61±14)μg/L]and[(28±9)μg/L],respectively(t=6.980,P<0.01;t=12.086,P<0.01).In the observation group,the serum CRP concentrations of patients with moderate and severe disease were[(14.6±2.1)mg/L]and[(16.5±3.3)mg/L],the serum TGF-β1 concentrations of patients with moderate and severe disease were[(61±13)μg/L]and[(76±18)μg/L],higher than those of patients with mild disease[(11.3±3.2)mg/L]and[(51±14)μg/L],and the level of patients with severe disease was increased more significantly(F=3.634,P<0.01;F=4.661,P<0.01).The serum CRP and TGF-β1 concentrations and disease severity were positively correlated(r=0.786,P<0.01;r=0.516,P<0.01).The serum levels of CRP and TGF-β1 in patients with pulmonary interstitial disease in the observation group[(15.5±3.2)mg/L and(74±19)μg/L]were higher than those without pulmonary interstitial disease[(10.5±2.2)mg/L and(51.6±13.8)μg/L](t=8.791,P<0.01;t=6.321,P<0.01).In the observation group,the serum CRP concentrations of patients with stageⅡand stageⅢof pulmonary interstitial disease were(16.3±8.2)mg/L and(19.1±10.1)mg/L,the serum TGF-β1 concentrations of patients with stageⅡand stageⅢof pulmonary interstitial disease were[(74±19)μg/L and(85±21)μg/L],higher than those of patients with stageⅠ[(63±15)μg/L],and the serum CRP and TGF-β1 concentrations of patients with stageⅢwere higher than those of patients with stageⅡ(F=4.640,P<0.01;F=5.673,P<0.01).There was a positive correlation between the serum CRP and TGF-β1 concentrations of patients with pSS and the stages of pulmonary interstitial disease(r=0.718,P<0.01,r=0.809,P<0.01).Conclusion The serum levels of CRP and TGF-β1 in patients with pSS are higher than those in healthy people.These two factors may be related to disease progress of pSS and the outcome of complicated pulmonary interstitial disease.