Urquizu-Padilla Maria, Balada Eva, Cortés Fina, Pérez Eduardo Hermosilla, Vilardell-Tarrés Miquel, Ordi-Ros Josep
Systemic Autoimmune Diseases Research Laboratory, Vall d'Hebron Research Institute, Hospital Vall d'Hebron, Barcelona, Spain.
J Rheumatol. 2009 May;36(5):953-60. doi: 10.3899/jrheum.080978. Epub 2009 Mar 30.
To perform a prospective evaluation of soluble CD40 ligand (sCD40L) levels according to the activity of systemic lupus erythematosus (SLE).
Two serum samples were taken from 53 patients with SLE: at flare and at remission. Clinical and biological measures (sCD40L levels were measured by a commercial ELISA) were evaluated in both situations.
Patients with SLE had significantly lower median levels of sCD40L during flare than during remission [3365 (6157) vs 7125 (4122) pg/ml; p < 0.001]. The multivariate analysis to explain those patients with lower values of sCD40L during flare than during remission included 3 variables: 2 related to flare (prednisone dose received <or= 15 mg/day and platelet counts > 192,000 x 10(6)/l) and one related to lower changes in SLE Disease Activity Index (SLEDAI) score. We regrouped patients with the 2 characteristics related to flare as Group 4, and the others were Group 123. All patients with low SLEDAI scores at flare had statistically significant lower sCD40L levels during flare than during remission. When flare SLEDAI scores were higher than the 50th percentile, patients of Group 123 showed the same behavior and even more diminished levels of sCD40L during flare than patients of Group 123 with low SLEDAI scores (p = 0.023); and patients of Group 4 showed no differences in the values of sCD40L between flare and remission (p = 0.241).
sCD40L plays a biologically active role, with decreased levels at flare at low SLEDAI scores. At high SLEDAI scores there are mechanisms that involve platelets and that are inhibited by high doses of prednisone that lead to increased serum values of sCD40L at flare.
根据系统性红斑狼疮（SLE）的活动情况对可溶性CD40配体（sCD40L）水平进行前瞻性评估。
从53例SLE患者中采集两份血清样本：一份在病情发作时采集，另一份在病情缓解时采集。对这两种情况下的临床和生物学指标（sCD40L水平通过商用ELISA法测定）进行评估。
SLE患者在病情发作时的sCD40L中位数水平显著低于病情缓解时[3365（6157）对7125（4122）pg/ml；p<0.001]。用于解释那些在病情发作时sCD40L值低于病情缓解时的患者的多变量分析包括3个变量：2个与病情发作相关（接受的泼尼松剂量≤15mg/天和血小板计数>192,000×10⁶/l），1个与SLE疾病活动指数（SLEDAI）评分的较低变化相关。我们将具有与病情发作相关的2个特征的患者归为第4组，其他患者归为第1、2、3组。所有在病情发作时SLEDAI评分较低的患者在病情发作时的sCD40L水平在统计学上显著低于病情缓解时。当病情发作时的SLEDAI评分高于第50百分位数时，第1、2、3组患者表现出相同的情况，并且在病情发作时第1、2、3组患者的sCD40L水平甚至比SLEDAI评分低的第1、2、3组患者更低（p=0.023）；而第4组患者在病情发作和病情缓解时的sCD40L值无差异（p=0.241）。
sCD40L发挥生物学活性作用，在SLEDAI评分低时病情发作时水平降低。在SLEDAI评分高时，存在涉及血小板的机制，且这些机制被高剂量泼尼松抑制，从而导致病情发作时sCD40L血清值升高。
