狼疮肾炎患儿外周血CD62P和CD44的表达及意义

目的 研究狼疮肾炎(LN)患儿外周血CD62P和CD44的表达水平,并探讨其临床意义.方法 22例活动期LN患儿按临床表现分为肾病综合征组(NS组)12例和非肾病综合征组(非NS组)10例;按肾活检病理分为病理Ⅱ+Ⅲ级组6例,病理Ⅳ+Ⅴ级组16例;按肾小管间质病变(TIL)程度分为TIL0级组5例.Ⅰ级组13例和Ⅱ级组4例.其中18例经治疗病情稳定3个月后复查血标本,作治疗前后的比较.同期门诊体检的健康儿童20名为对照组.分别采用放射免疫法(RIA)和酶联免疫吸附试验(ELISA)测定患儿外周血CD62P和CD44表达水平,并分析其与临床指标的相关性.结果 ①活动期LN患儿外周血CD62P和CD44水平明显高于稳定期患儿和健康对照组(均P<0.01).②NS组、病理Ⅳ+Ⅴ级组患儿外周血CD62P和CD44水平分别高于非NS组患儿(均P<0.01)、病理Ⅱ+Ⅲ级组(均P<0.01).③外周血CD62P和CD44水平与尿蛋白定量(24 h)、红细胞沉降率(ESR)、尿N-乙酰-氨基葡萄糖苷酶(NAG)、尿β2微球蛋白(β2-MG)和TIL病变分级呈正相关(分别P<0.01和P<0.05),与血补体C3和血白蛋白(ALB)水平负相关(P<0.05).外周血CD62P水平和CD44水平正相关(P<0.05).结论 CD62P和CD44参与了儿童LN的发生,外周血CD62P和CD44水平与LN的活动性和肾病变程度.尤其是与TIL程度密切相关,动态监测其表达水平可作为反映狼疮活动、判断LN严重程度、观察疗效和评估预后的指标之一.

Expression and clinical significances o f CD62P and CD44 in the peripheral blood of children with lupus nephritis

Objective To study the levels of CD62P and CD44 in the peripheral blood of children with lupus nephritis (LN) and their clinical significances were investigated. Methods Twenty-two children with active LN were divided into two groups by their clinical features,nephritic syndrome group (NS group,12 patients) and nonnephritic syndrome group (non NS group, 10 patients). Those patients were also divided into two groups according to their pathologic grading,grade Ⅱ+Ⅲ group (6 patients) and grade Ⅳ+Ⅴ group(16 patients).According to their tubulointerstitial lesions (TIL), those patients were divided into three groups, TIL grade 0 group (5 patients), grade Ⅰ group (13 patients), grade Ⅱ group (4 patients). The blood of the 18 patients who were in inactive state after treatment were retested blood again. The levels of CD62P and CD44 in the peripheral blood were assayed by radioimmunoassay (RIA) and enzyme-linked immunoabsorbant assay (ELISA) in LN children and in 20 normal age and sex-matched controls, and their correlation with clinical peripheral blood levels of CD62P and CD44 in NS group, grade Ⅳ+Ⅴ group were significantly higher than CD44 were positively correlated with 24-hour proteinuria,ESR, urine NAG, urine β2-MG and the TIL grade (P<0.05 and P<0.01, respectively), but negatively correlated with the levels of serum complement 3 (C3) and albumin (ALB) (P<0.05).The levels of CD62P was positively correlated with those of CD44 (P<0.05). Conclusion CD62P and CD44 may be involved in the pathogenesis of LN. The peripheral blood levels of CD62P and CD44 in LN children could be used as one of the indicators for lupus activity, severity, treatment effectiveness and prediction of outcome.