目的 檢測系統性紅斑狼瘡（SLE）患者CD4+CD25+調節性T細胞（Treg）上Ⅰ型干擾素受體（IFNAR）的分布格局，了解Ⅰ型干擾素對SLE患者CD4+CD25+Treg產生直接影響的作用靶點。 方法 選取2010年9月－2011年10月間20例初次確診的SLE患者（SLE組）和20例健康女性（對照組），分離SLE患者和對照組的外周血單個核細胞，采用流式細胞術測定CD4+CD25+Treg上IFNAR的表達。 結果 ① IFNAR1、IFNAR2在Treg和CD4+CD25? T細胞表面均有表達；兩組Treg表面IFNAR1和IFNAR2的表達水平均高于CD4+CD25? T細胞。② 與對照組相比，SLE組Treg表面IFNAR1表達的平均熒光強度明顯增高（P=0.001）。③ SLE組Treg表面IFNAR1表達平均熒光強度與疾病活動指數評分呈正相關（rs=0.505，P=0.023）。 結論 SLE患者CD4+CD25+Treg表面相對高表達IFNAR1且與疾病活動性相關，提示Ⅰ型干擾素以Treg上IFNAR為靶點在SLE發病機制中可能發揮重要作用，為SLE等自身免疫性疾病治療尋找新的干預手段提供了理論基礎。
【摘要】 目的 以99mTc-DTPA腎動態顯像法腎小球濾過率（glomerular filtration rate，GFR）測定為標準，將血清胱抑素C（cystatin C， CysC）檢測與其比較，探討CysC測定在2型糖尿病腎病（type 2 diabetic nephropathy，T2DN）診斷中的意義。 方法 2010年6月—2011年1月76例2型糖尿病（type 2 diabetes mellitus，T2DM）患者按24 h尿微量白蛋白（microalbuminuria，m-Alb）分為兩組:正常蛋白尿組（31例）和微量蛋白尿組（45例），同時測定GFR、CysC、血清肌酐（serum creatinine， Scr）和糖化血紅蛋白（hemoglobin A1c， HbA1c），并設正常自愿者38名作為對照組，進行統計學分析。 結果 對照組、T2DM正常蛋白尿組及T2DM微量蛋白尿組CysC水平分別為（1.1±0.6）、（1.6±0.7）、（1.0±0.3） mg/L，各組差異均有統計學意義（Plt;0.05）；HbA1c水平分別為（5.4±0.6）%、（7.1±2.7）%、（7.9±3.1）%、兩組T2DM患者與對照組比較，差異均有統計學意義（Plt;0.05）；GFR水平分別為（80.9±23.0）、（74.2±26.1）、（79.3±19.7） mL/（min?1.73 m2），各組差異無統計學意義（Pgt;0.05）；Scr水平分別為（87.7±23.8）、（93.7±38.4）、（81.5±11.4） μmol/L，組間差異無統計學意義（Pgt;0.05）。CysC、Scr和GFR之間呈負相關（r=-0.694，-0.692；Plt;0.001）；CysC和Scr之間呈正相關（r=0.903，Plt;0.001）。 結論 CysC可作為早期T2DN的檢測指標，具有較高的敏感性，但對于輕度到中度GFR降低的診斷準確性并不優于Scr。【Abstract】 Objective To demonstrate the clinical value of serum cystatin-C (CysC) in the assessment of renal function in type-2 diabetic nephropathy (T2DN) by comparing it with the glomerular filtration rate (GFR) measured by 99mTc-DTPA method. Methods From June 2010 to January 2011, 76 patients with type 2 diabetes mellitus (T2DM) were classified into two groups according to their 24 h microalbuminuria (m-Alb) level: the normal albuminuric group (n=31) and the microalbuminuric group (n=45). GFR, Serum creatinine (Scr), CysC, and hemoglobin A1c (HbA1c) were measured. Thirty-eight healthy subjects were recruited as the control group, and statistical analysis was carried out. Results The CysC levels in the control group, the normal albuminuric group and the microalbuminuria group were respectively (1.1±0.6), (1.6±0.7) and (1.0±0.3) mg/L, with a significant difference among the three groups (Plt;0.05). HbA1c level in the three groups were respectively (7.1±2.7)%, (7.9±3.1)% and (5.4±0.6)%, with a significant difference between the two diabetic groups and the control group (Plt;0.05). Scr levels in the three groups were respectively (87.7±23.8), (93.7±38.4), (81.5±11.4) μmol/L; GFR levels in the three groups were respectively (80.9±23.0), (74.2±26.1), (79.3±19.7) mL/(min?1.73 m2); among the three groups the differences of both Scr and GFR were not significant. Both CysC and Scr were negatively correlated with GFR (r=-0.694,-0.692;Plt;0.001), and CysC was positively correlated with Scr (r=0.903, Plt;0.001). Conclusion Increased CysC may be an early indicator of incipient diabetic nephropathy, but the diagnostic accuracy of CysC is not superior to that of Scr in distinguishing between mildly and moderately reduced GFR.