性别差异对系统性红斑狼疮及狼疮肾炎的影响

    The impacts of gender differences on systemic lupus erythematosus and lupus nephritis

    • 摘要: 系统性红斑狼疮(systemic lupus erythematosus,SLE)是常见的自身免疫性疾病,而狼疮肾炎是其常见并发症之一,其临床表现存在性别差异;男女发病率之比在不同年龄段是不同的;而且,SLE患者中,男性和女性的临床表现也是存在性别差异的。认识性别差异对SLE及狼疮肾炎的影响,可能关系到患者的治疗及远期预后。研究证实,多种因素与SLE及狼疮肾炎的发病有关,但具体机制仍不能完全明确。性激素在其中起了非常重要的作用,包括雌激素、雄激素及孕激素。雌激素可通过与雌激素受体结合,调节T淋巴细胞、B淋巴细胞及细胞因子影响SLE的发病。雄激素亦可通过雄激素受体发挥其生理作用。由于雄激素受体在胸腺和骨髓的细胞中表达,而在外周血淋巴细胞中并未见表达,这表明雄激素可能对淋巴细胞功能没有直接影响,但其在T和B淋巴细胞的发育阶段起着重要作用。孕激素作为一种免疫调节分子通过与孕激素受体结合发挥免疫效应。此外,性染色体及常染色体均在SLE的发病机制中起了非常重要的作用,影响基因表达。环境因素通过对表观遗传模式的影响可能导致同卵双胞胎患病不同。而肠道菌群的性别差异对SLE的发病亦有一定程度的影响。性别差异可能会影响个体化治疗方案的不同,仍需进一步研究。

       

      Abstract: Systemic lupus erythematosus is a common autoimmune disease,and lupus nephritis is one of its common complications. Their clinical manifestations have differences. The incidence ratio of male to female varies by age group. Moreover,there are gender differences in the clinical manifestations of SLE in men and women. Understanding the effects of gender differences on systemic lupus erythematosus and lupus nephritis may be related to the treatment and long-term prognosis of patients. Studies have shown that many factors are involved, but the exact mechanism is still unclear. Sex hormones play a very important role. These hormones include estrogen,androgen and progesterone. By binding to estrogen receptors,estrogen regulates T lymphocytes,B lymphocytes and cytokines to affect the pathogenesis of SLE. Androgen also plays its physiological role through androgen receptors. Androgen receptors are expressed in thymus and bone marrow cells but not in peripheral blood lymphocytes. This suggests that androgens may not have a direct effect on lymphocyte function, but they do play an important role in the development of T and B lymphocytes. Progesterone acts as an immunoregulation molecule by binding to progesterone receptors. In addition,both sex chromosomes and autosomes play important roles in the pathogenesis of SLE, affecting gene expression. Environmental factors may lead to different diseases in identical twins by influencing epigenetic patterns. Gender differences in intestinal flora also have a certain impact on the incidence of SLE. Gender differences may affect the differences in individualized treatment regimens,and further research is needed.

       

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