炎症因子对系统性红斑狼疮免疫易栓状态的影响

Influence of inflammatory cytokine on immune hypercoagulable state on patients with systemic lupus er-ythematosus

目的：探讨炎症因子对系统性红斑狼疮（ SLE）患者易栓状态的干预作用。方法以36例确诊SLE患者及30名正常对照者为研究对象，通过SLE疾病活动指数（ SLEDAI）评价SLE患者病情活动程度；采用ELISA法检测炎症因子IL?1β、IL?6、IL?8、IL?18、TNF?α的浓度；以磁珠法检测血凝常规包括血浆凝血酶原时间（ PT）、活化的部分凝血活酶时间（ APTT）、纤维蛋白原（ FIB）、凝血酶时间（ TT）以及血浆D二聚体（D?D）、抗凝血酶（AT）。结果（1）与正常对照组相比，炎症因子 IL?1β（t＝33．209，P＜0．001）、IL?6（t＝11．005，P＜0．001）、IL?8（t＝13．419，P＜0．001）、IL?18（t＝15．693， P＜0．001）、TNF?α（t＝14．933，P＜0．001）在SLE患者体内表达明显升高，炎症因子IL?1β（ t＝5．229，P＜0．001）、IL?6（ t＝4．848， P＜0．001）、IL?8（ t＝19．827，P＜0．001）、IL?18（ t＝6．344，P＜0．001）、TNF?α（ t＝7．655，P＜0．001）在SLE活动期患者体内表达较非活动期患者升高。（2）与正常对照组相比，SLE患者血浆D?D表达浓度明显升高（t＝－6．700，P＜0．001），AT表达减少（t＝5．274，P＜0．001）；D?D（t＝3．163，P＝0．003）、AT（t＝－3．194，P＝0．003）在活动期与非活动期SLE患者体内表达差异有统计学意义。（3） SLE患者的炎症因子IL?1β（ r＝0．359，P＝0．032）、IL?6（ r＝0．863，P＜0．001）、IL?8（ r＝0．644，P＜0．001）、IL?18（ r＝0．535，P＝0．001）表达浓度与其SLEDAI评分呈正相关。（4）在SLE患者体内，炎症因子IL?1β（r＝0．407，P＝0．014）、IL?8（r＝0．496，P＝0．002）、IL?18（ r＝0．390，P＝0．019）、TNF?α（ r＝0．808，P＜0．001）表达浓度与血浆D?D呈正相关。结论 SLE患者炎症因子IL?1、IL?6、IL?8、IL?18、TNF?α浓度与其病情活动相关，且导致患者机体凝血?纤溶系统异常，形成有利于血栓形成的免疫炎性易栓状态。

Objective To study the role of inflammatory cytokine on immune hypercoagulable state of the patients with systemic lupus erythematosus( SLE) . Methods Thirty?six cases patients with SLE who were e?valuated by the SLE disease activity index( SLEDAI) and 30 cases normal persons were selected as study sub?jects. The level of IL?1β, IL?6, IL?8, IL?18 and TNF?α were detected by enzyme linked immunosorbent assay (ELISA). Blood clotting routine including plasma prothrombin time(PT),activated part of clotting enzyme live time( APTT) ,fibrinogen( FIB) ,thrombin time( TT) and plasma D dimer( D?D) and antithrombin( AT) were de?tected by magnetic beads method. Results ( 1) Compared with normal control group,the level of inflammatory cytokine IL?1β(t=33. 209,P<0. 001),IL?6(t=11. 005,P<0. 001),IL?8(t=13. 419,P<0. 001),IL?18(t=15. 693,P<0. 001) and TNF?α(t=14. 933,P<0. 001) in patients with SLE were increased obviously,and compared with the group of inactivity SLE patients, the level of inflammatory cytokine IL?1β( t=5. 229, P<0. 001),IL?6(t=4. 848,P<0. 001),IL?8(t=19. 827,P<0. 001),IL?18(t=6. 344,P<0. 001) and TNF?α(t=7. 655,P<0. 001) in activity SLE patients was increased. (2)Compared with normal control group,the level of D?D(t=-6. 700,P<0. 001) in patients with SLE was increased obviously,and the level of AT(t=5. 274,P<0. 001) was reduced. The level of D?D( t=3. 163,P=0. 003) and AT( t=-3. 194,P=0. 003) in activity SLE patients had statistically significant with inactivity SLE patients. ( 3) There were positive correlation between the level of IL?1β( r=0. 359,P=0. 032) ,IL?6( r=0. 863,P<0. 001) ,IL?8( r=0. 644,P<0. 001) ,IL?18( r=0. 535, P=0. 001) and the SLEDAI of SLE patients. ( 4) There were positive correlation between the level of IL?1β( r=0. 407,P=0. 014),IL?8(r=0. 496,P=0. 002),IL?18(r=0. 390,P=0. 019),TNF?α(r=0. 808,P<0. 001)&nbsp;and the level of D?D in SLE patients. Conclusion The level of IL?1,IL?6,IL?8,IL?18 and TNF?α have highly correlation with disease activity for SLE patients,and have the influence on coagulation?fibrinolysis system as well as led to immune hypercoagulable state.