Tesar V, Jirsa M, Masek Z, Bartůnková J, Stejskalová A, Dostál C, Zabka J, Chábová V, Rysavá R
I. interní klinika 1, Praha.
Cas Lek Cesk. 1998 May 4;137(9):271-5.
Activation of various cytokines, e.g. TNF alpha, IL-1 and/or IL-6 may play important role in the pathogenesis of renal vasculitis and lupus nephritis (LN). Systemic effects of these cytokines may be modulated by their circulating soluble receptors. Plasma levels of cytokine receptors may thus be also markers of the activation of these cytokines.
Plasma levels of TNF alpha, its soluble receptor p75 (sTNF-RII), IL-6 and soluble IL-6 receptor (sIL-6R) were measured using ELISA in 17 pts with ANCA-positive renal vasculitis (12 active-ANCA-A, 7 in remission ANCA-R), 9 pts with active lupus nephritis (LN) and 5 healthy subjects. Pts with LN had in comparison with controls increased plasma levels of TNF alpha, sTNF-RII, IL-6 and sIL-6R. Pts with ANCA-A had also in comparison with controls increased plasma levels of TNF alpha, sTNF-RII and sIL-6R, but plasma levels of IL-6 were not significantly increased dut to great standard deviation. Pts with ANCA-R had in comparison with controls increased plasma levels of sTNF-RII, but plasma levels of TNF alpha were in ANCA-R significantly lower than in ANCA-A. While the ratio TNF alpha/sTNF-RII was significantly lower in all groups of pts than in controls, the ratio IL-6R/sIL-6R was in comparison with controls significantly increased only in LN.
While increased plasma levels of TNF alpha may be nonspecific marker of the activity of ANCA-positive renal vasculitis and LN, plasma levels of sTNF-RII are increased also in pts with ANCA-positive renal vasculitis in remission. Increased plasma levels of sTNF-RII may interfere with systemic effects of TNF alpha, but may also prolong the lifetime of its active form. Plasma levels of sIL-6R are increased both in ANCA-A and in LN, but their increase is, however, much less pronounced than that of sTNF-RII and cannot effectively block systemic effects of IL-6.
多种细胞因子如肿瘤坏死因子α（TNFα）、白细胞介素-1（IL-1）和/或白细胞介素-6（IL-6）的激活可能在肾血管炎和狼疮性肾炎（LN）的发病机制中起重要作用。这些细胞因子的全身效应可能受其循环可溶性受体的调节。因此，细胞因子受体的血浆水平也可能是这些细胞因子激活的标志物。
采用酶联免疫吸附测定法（ELISA）检测了17例抗中性粒细胞胞浆抗体（ANCA）阳性肾血管炎患者（12例活动期ANCA-A，7例缓解期ANCA-R）、9例活动期狼疮性肾炎（LN）患者和5名健康受试者血浆中TNFα、其可溶性受体p75（sTNF-RII）、IL-6和可溶性IL-6受体（sIL-6R）的水平。与对照组相比，LN患者血浆中TNFα、sTNF-RII、IL-6和sIL-6R水平升高。与对照组相比，ANCA-A患者血浆中TNFα、sTNF-RII和sIL-6R水平也升高，但由于标准差较大，IL-6的血浆水平没有显著升高。与对照组相比，ANCA-R患者血浆中sTNF-RII水平升高，但ANCA-R患者血浆中TNFα水平显著低于ANCA-A患者。虽然所有患者组中TNFα/sTNF-RII的比值均显著低于对照组，但与对照组相比，只有LN患者中IL-6R/sIL-6R的比值显著升高。
虽然血浆中TNFα水平升高可能是ANCA阳性肾血管炎和LN活动的非特异性标志物，但缓解期ANCA阳性肾血管炎患者血浆中sTNF-RII水平也升高。血浆中sTNF-RII水平升高可能会干扰TNFα的全身效应，但也可能延长其活性形式的寿命。ANCA-A和LN患者血浆中sIL-6R水平均升高，但其升高程度远不如sTNF-RII明显，且不能有效阻断IL-6的全身效应。
