114例中重度系统性红斑狼疮患儿的淋巴细胞亚群特征及治疗后随访

摘要

目的 探讨中重度疾病活动系统性红斑狼疮(SLE)患儿的淋巴细胞亚群临床特征,并比较治疗6个月后的相应变化.方法 回顾性分析2013年1月～2018年1月广州市妇女儿童医疗中心收治的114例中重度疾病活动 SLE患儿临床资料,主要分析其免疫学指标及淋巴细胞亚群分类结果.根据疾病活动度评分(SLEDAI)分为中度活动组及重度活动组,比较组间有无差异,并将组间治疗6个月后的SLEDAI、淋巴细胞亚群计数及免疫学指标进行统计学比较分析.结果 114例患儿的平均年龄为(10.56±2.65)岁,女:男=3.56:1,SLEDAI 评分为(15.21±3.95)分,其中、中度活动组49例,重度活动组65例.疾病重度活动组的补体C3及C4均明显低于中度活动组(P<0.05),淋巴细胞亚群分类结果显示,中度活动组的NK 细胞(CD16+CD56+)计数明显高于重度活动组(P<0.05),重度疾病活动组的CD4+/CD8+比值明显低于中度活动组(P<0.05).治疗6个月后的SLEDAI 评分与首诊比较明显降低(P<0.05),IgG、IgA、IgE水平均明显减低(P<0.05),C4、CD8+ T 淋巴细胞计数明显增高(P<0.05),CD19+ B 淋巴细胞计数明显减低(P<0.05).结论 免疫学指标联合淋巴细胞亚群分类能部分反映SLE患儿的临床治疗效果, SLEDAI在指导临床治疗及分级治疗中有重要作用,值得在儿科临床工作中加以推广.%Objective To analyze the clinical manifestations of lymphocyte subsets in systemic lupus erythematosus (SLE) children with moderate or severe disease activity, and to compare their corresponding changes after 6 months of treatment. Methods Clinical data of 114 patients with moderate and SLE disease activity index (SLEDAI) in Women's and Children's Medical Center of Guangzhou City from January 2013 to January 2018 were retrospectively analyzed. The immunological indicators and lymphocyte subgroup classification results were analyzed. According to the SLEDAI, patients were divided into the moderate activity group (MAG) and the severe activity group (SAG) for further contrast, and the SLEDAI, lymphocyte subsets and immunological indices after 6 months of treatment were compared and statistically analyzed. Results The average age of 114 children was (10.56±2.65) years old, with a 1:3.56 male-female proportion. The score of SLEDAI was (15.21±3.95) points, with 49 MAG patients and 65 SAG patients. The complement C3 and C4 of MAG were significantly lower than that of SAG (P<0.05). The NK cells (CD16+CD56+) of MAG was significantly higher than those of SAG (P<0.05), and CD4+/CD8+ of the SAG were significantly higher than those of MAG (P<0.05). The SLEDAI score after 6 months of treatment was significantly lower than that at the first visit (P<0.05), and the level of IgG, IgA and IgE were significantly lower (P<0.05), and CD19+ were lower, while C4 and CD8+ were significantly higer (P<0.05). Conclusion Immunological indicators combined with lymphocyte subgroup classification can partly reflects the clinical treatment effect of SLE children patients, and has a good correlation with SLEDAI, which is worth promoting in clinical work.