CAJ | 학술논문

目的探讨镓铝砷激光联合药物治疗类风湿关节炎(RA)的机制.方法将22例RA患者分为观察组和对照组,每组11例.观察组采用镓铝砷激光+甲氨蝶呤治疗,对照组仅采用甲氨蝶呤治疗.采用流式细胞双抗染色法分别测定患者治疗前、后外周血和膝关节滑液中CD4+CD25+treg(调节性T细胞)的数量,采用酶联免疫吸附法测定治疗前、后患者膝关节滑液中前列腺素E2(PGE2)的含量.同时检测10名健康人(正常对照组)外周血CD4+CD25+treg细胞数量.结果观察组膝关节局部症状改善优于对照组;2组治疗后膝关节滑液中PGE2含量分别为(3.82±1.34)和(1.69±0.98),均较治疗前下降,其中观察组下降幅度明显高于对照组,差异具有统计学意义(P＜0.05);患者外周血CD4+CD25+treg细胞数量为(3.84±3.20)%,明显低于正常对照组,差异存在统计学意义(P＜0.05).滑液中CD4+CD25+treg远多于外周血.观察组治疗后关节滑液中CD4+CD25+treg的数量为(9.78±10.28)%,与治疗前比较差异存在统计学意义(P＜0.05).结论镓铝砷激光联合甲氨蝶呤治疗类风湿关节炎临床疗效优于单纯应用甲氨蝶呤,联合治疗的机制可能在于明显减少靶器官局部炎性介质和CD4+CD25+treg细胞数量.
목적 탐토가려신격광연합약물치료류풍습관절염(RA)적궤제.방법 장22례RA환자분위관찰조화대조조,매조11례.관찰조채용가려신격광+갑안접령치료,대조조부채용갑안접령치료.채용류식세포쌍항염색법분별측정환자치료전、후외주혈화슬관절활액중CD4+CD25+treg(조절성T세포)적수량,채용매련면역흡부법측정치료전、후환자슬관절활액중전렬선소E2(PGE2)적함량.동시검측10명건강인(정상대조조)외주혈CD4+CD25+treg세포수량.결과 관찰조슬관절국부증상개선우우대조조;2조치료후슬관절활액중PGE2함량분별위(3.82±1.34)화(1.69±0.98),균교치료전하강,기중관찰조하강폭도명현고우대조조,차이구유통계학의의(P＜0.05);환자외주혈CD4+CD25+treg세포수량위(3.84±3.20)%,명현저우정상대조조,차이존재통계학의의(P＜0.05).활액중CD4+CD25+treg원다우외주혈.관찰조치료후관절활액중CD4+CD25+treg적수량위(9.78±10.28)%,여치료전비교차이존재통계학의의(P＜0.05).결론 가려신격광연합갑안접령치료류풍습관절염림상료효우우단순응용갑안접령,연합치료적궤제가능재우명현감소파기관국부염성개질화CD4+CD25+treg세포수량.
Objective To explore the mechanism of combined treatment with methotrexate (MTX) and Ga-Al-As laser irradiation for rheumatoid arthritis (RA) and to assess the effectiveness of Ga-Al-As laser therapy for RA. Methods Twenty-two patients with RA were randomly and evenly divided into two groups: the treatment group treated with Ga-Al-As laser irradiation combined with MTX and the control group treated with MTX only. Ten age-matched normal subjects were observed as normal controls. The amount of CD4 + CD25 + regulatory T cells in peripheral blood (PB) of the normal controls and that in the PB and synovial fluid (SF) of the 22 patients before and after therapy were counted by flow cytometry. Meanwhile, the amount of prostaglandin E2 (PGE2) in synovial fluid of the patients was measured before and after treatment by enzyme-linked immunosorbent assay(ELISA). Results After combined treatment the clinical symptoms of the patients were improved significantly, and the amount of PGE2in SF decreased significantly. The count of CD4 + CD25 + regulatory T cells in PB of RA patients was ( 3.84 ±3.20) % , compared to ( 10.05 ± 7.04) % in healthy individuals. The count of CD4 + CD25 + regulatory T cells in SF of RA patients was ( 14.89 ± 12.30) % , much higher than that in PB. The count of CD4 + CD25 + regulatory T cells in SF decreased significantly in treatment group compared to control group (P ＜0.05). Conclusion Ga-Al-As laser irradiation eombined with MTX can effectively improve the clinical symptoms of RA patients. It may be related to the decrease of amount of PGE2 and count of CD4 + CD25 + regulatory T cell in PB and SF.