低剂量IL-2辅助他克莫司治疗系统性红斑狼疮及对树突状细胞相关细胞因子、甲襞微循环的影响

Low dose IL-2 adjuvant to tacrolimus therapy in the treatment of systemic lupus erythematosus and its effect on Dendritic cell-related cytokines and nailfold capillaroscopy

目的研究低剂量白细胞介素(IL)-2辅助他克莫司治疗系统性红斑狼疮(SLE)及对树突状细胞相关细胞因子(DCRC)、甲襞微循环(NC)的影响。方法前瞻性选择2017年7月至2020年6月入住洪湖市人民医院的SLE患者82例,按照随机数字表法将82例SLE患者分为试验组(n=41)与对照组(n=41)。对照组给予他克莫司胶囊1 mg/d,2次/d,共5周。试验组给予低剂量IL-2+他克莫司治疗,他克莫司同对照组,IL-2注射液100万U/m 2,皮下注射,隔日1次,2周1个疗程,1个疗程后间隔1周,共2个疗程。观察2组患者治疗前、治疗后3个月SLEDAI评分、红细胞沉降率(ESR)及补体C3、C4等SLE活动指标水平,血清IL-6、IL-10、IL-23等DCRC指标水平,NC积分和不良反应。结果治疗前,2组患者SLEDAI评分、ESR及补体C3、C4水平、DCRC指标水平、NC积分比较,差异均无统计学意义(P>0.05);治疗后3个月,试验组SLEDAI评分、ESR水平分别为(5.64±0.61)分、(25.09±2.75)mm/h,均低于对照组[(6.06±0.63)分、(27.06±3.08)mm/h],补体C3、C4水平分别为(1.18±0.13)、(0.35±0.05)mg/L,均高于对照组[(1.10±0.12)、(0.32±0.04)mg/L],差异均有统计学意义(P<0.05)。试验组血清IL-6、IL-10及IL-23水平分别为(22.75±2.37)、(34.86±3.64)、(100.75±11.38)pg/mL,均低于对照组[(24.38±2.63)、(37.44±3.91)、(108.87±12.73)pg/mL],差异均有统计学意义(P<0.05)。试验组袢周积分、流态积分、形态积分及总分分别为(1.28±0.15)、(1.32±0.15)、(1.25±0.14)、(3.87±0.41)分,均小于对照组[(1.39±0.17)、(1.43±0.16)、(1.34±0.15)、(4.15±0.45)分],差异均有统计学意义(P<0.05)。试验组总有效率(92.68%)大于对照组(73.17%),差异有统计学意义(P<0.05)。治疗期间,2组均未见明显不良反应。结论低剂量IL-2辅助他克莫司治疗SLE可增强机体自身免疫耐受能力,降低SLE活动性,改善DCRC水平,促进NC,提高疗效,安全性高。

Objective To study the effects of low dose interleukin(IL)-2 adjuvant to tacrolimus therapy in the treatment of systemic lupus erythematosus(SLE)and its effect on Dendritic cell-related cytokines(DCRC)and nailfold capillaroscopy(NC).Methods A total of 82 patients with SLE admitted to Honghu Municipal People's Hospital from July 2017 to June 2020 were selected and divided into experimental group(n=41)and control group(n=41)according to random number table method.The control group was treated with tacrolimus treatment,tacrolimus capsule 1 mg/d,twice/d,for 5 weeks.The experimental group was treated with low dose IL-2+tacrolimus,tacrolimus and control group,IL-2 injection 1 million U/m 2,subcutaneous injection,once every other day,2 weeks/1 course of treatment,1 week interval after 1 course of treatment,a total of 2 courses of treatment.SLEDAI score,erythrocyte sedimentation rate(ESR),complement C3,C4 and other SLE activity index levels,serum IL-6,IL-10,IL-23 and other DCRC index levels,NC score before treatment and 3 months after treatment,adverse reactions were observed.Results Before treatment,there was no significant difference in SLEDAI score,ESR and complement C3,C4 level,DCRC index level,and NC score between the two groups of patients(P>0.05);At 3 months after treatment,SLEDAI score and ESR level in experimental group were(5.64±0.61)score,(25.09±2.75)mm/h,which were lower than those in control group[(6.06±0.63)score,(27.06±3.08)mm/h],and complement C3 and C4 levels were(1.18±0.13),(0.35±0.05)mg/L,which were higher than those in control group[(1.10±0.12),(0.32±0.04)mg/L],the differences were statistically significant(P<0.05).The levels of serum IL-6,IL-10 and IL-23 in experimental groups were(22.75±2.37),(34.86±3.64),(100.75±11.38)pg/mL,which were lower than those in control group[(24.38±2.63),(37.44±3.91),(108.87±12.73)pg/mL],the differences were statistically significant(P<0.05).Loop cycle integral,flow state integral,morphological integral and total score in experimental group were(1.28±0.15),(1.32±0.15),(1.25±0.14),(3.87±0.41)score,which were lower than those in control group[(1.39±0.17),(1.43±0.16),(1.34±0.15),(4.15±0.45)scores],the differences were statistically significant(P<0.05).The total effective rate of experimental group(92.68%)was higher than that of control group(73.17%),the difference was statistically significant(P<0.05).During the treatment,no obvious adverse reactions were observed in the two groups.Conclusion Low dose IL-2 adjuvant to tacrolimus therapy treatment of SLE can enhance the body's autoimmune tolerance,reduce SLE activity,improve the level of DCRC,promote NC,improve the efficacy and safety.