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目的初步探讨脐带间充质干细胞(umbilical cord mesenchymal stem cells,UC-MSC)联合利妥昔单抗(rituximab,美罗华)与甲强龙对系统性红斑狼疮(systemic lupus erythematosus,SLE)患者免疫炎性易栓状态的干预作用。方法8例SLE患者经肾活检确诊为狼疮性肾炎。予SLE活动指数(SLEDAI积分)评价病情活动程度;流式细胞术(FCM)监测B细胞清除、T细胞亚群及炎症介质表达水平;酶联免疫吸附法(ELISA)检测抗心磷脂抗体(ACA)、狼疮抗凝物(LA)水平;以磁珠法检测血凝常规、血浆D二聚体(D-D)、抗凝血酶(AT)等。结果随访第1个月临床症状明显改善,CD19和CD20降至“0”;至第3个月全组SLEDAI评分<4分,Th1(IFN-γ)、Th2(IL-4)及CD11b、CD25水平均接近正常;随访至1年上述指标维持在正常值内。结论利妥昔单抗联合UC-MSC所具有的靶向作用,能有效清除外周血致病性B细胞,恢复Th1/Th2免疫平衡状态,减少炎症因子释放,促进机体免疫重建,恢复凝血-抗凝系统平衡,从而改善机体免疫炎性易栓状态。
Objective To investigate the effects of umbilical cord mesenchymal stem cells (UC-MSCs) combined with rituximab (Rituximab) and methylprednisolone on immune and inflammatory cytokines in patients with systemic lupus erythematosus (SLE) Easy to plug state of intervention. Methods Eight patients with SLE were diagnosed as lupus nephritis by renal biopsy. SLE activity index (SLEDAI score) was used to assess the degree of disease activity. Flow cytometry (FCM) was used to detect the expression of B cell depletion, T cell subsets and inflammatory mediators. ELISA was used to detect anti-cardiolipin antibody ), And lupus anticoagulant (LA). The routine blood coagulation test, plasma D dimer (DD) and antithrombin (AT) were detected by magnetic beads method. Results The clinical symptoms in the first month of follow-up were significantly improved, and the levels of CD19 and CD20 decreased to “0”. By the third month, the patients’ SLEDAI score <4, Th1, Th2 and CD11b , CD25 levels were close to normal; follow-up to 1 year these indicators remain within the normal value. Conclusions Rituximab combined with UC-MSCs can effectively remove peripheral blood-borne B cells, restore Th1 / Th2 immune balance, reduce the release of inflammatory cytokines, promote the immune reconstitution, and restore coagulation-anti Condensate system balance, thereby improving the body immune inflammation easily plug the state.