Терапевтический потенциал плазмафереза при красной волчанке: биомаркеры и динамика

Введение. Красная волчанка (КВ) представляет собой гетерогенное аутоиммунное заболевание, в патогенезе которого важную роль играют провоспалительные цитокины. Несмотря на значительное количество исследований, особенности цитокинового профиля при кожной форме КВ (ККВ), а также его изменения в ответ на плазмаферез остаются недостаточно изученными. Цель. Оценить уровни IL-17A, IL-31, IL-13 и IL-10 у пациентов с дискоидной (ДКВ) и системной (СКВ) формами КВ, а также их динамику после мембранного плазмафереза.

Материалы и методы. В исследование включены 30 пациентов (21 – с ДКВ, 9 – с СКВ), проходивших лечение в МНПЦДК ДЗМ. Уровни цитокинов определялись до начала лечения, после первой процедуры плазмафереза и через 14 дней. Результаты сопоставлялись с референсными значениями.

Результаты. У пациентов с ДКВ исходно выявлено повышение IL-17A и IL-31. После первой процедуры отмечено снижение уровня IL-17A и IL-13 при резком увеличении IL-31. Через 14 дней сохранялось снижение IL-17A и IL-10, IL-13 восстановился до исходного уровня, IL-31 оставался повышенным. При СКВ отмечалось умеренное снижение IL-17A и повышение IL-13 и IL-10. Через 14 дней IL-17A и IL-10 снижались, IL-13 демонстрировал выраженные колебания, а IL-31 оставался стабильным в обоих случаях.

Выводы. Плазмаферез оказывает модулирующее влияние на уровни цитокинов у пациентов с КВ. IL-31 и IL-10 могут рассматриваться как потенциальные биомаркеры активности и системного прогрессирования. Полученные данные подтверждают целесообразность включения плазмафереза в терапию резистентных форм КВ.

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