CAJ | 학술논문

目的通过检测类风湿关节炎(RA)患者外周血滤泡辅助性T细胞(Tfh)和细胞因子白细胞介素(IL)-21,CXCL13的表达并与健康者比较,探讨其与RA临床表现的相关性及其可能的免疫学发病机制.方法流式细胞仪检测患者和健康对照外周血中Tfh细胞的变化；酶联免疫吸附试验( ELISA)法检测RA患者及健康对照者血浆中IL-21、CXCL13等细胞因子的水平.采用t检验、单因素方差分析和SNK-q检验、z2检验、Spearman秩和相关分析以及多元线性回归分析.结果 RA患者外周血中Tfh比例显著高于对照组(3.0±1.2与1.1±0.4,P＜0.01)；同时RA患者轻、中、重度活动组外周血Tfh的比例依次增多(1.8+0.7,2.5±0.6与4.0+1.2),3组之间比较差异均有统计学意义(P均＜0.01),且均较对照组升高(P＜0.01)；Tfh细胞数与RA患者DAS28、红细胞沉降率(ESR)、C反应蛋白(CRP)、关节压痛数、骨质破坏、RF及抗环瓜氨酸肽(CCP)抗体滴度呈正相关；严重骨质破坏组Tfh表达率明显高于轻度或无骨质破坏组(2.7+1.1与3.4±1.3)；未治疗组相比非正规治疗组、正规治疗组的Tfh表达率逐渐降低(P均＜0.01)；正规治疗组的Tfh表达率低于非正规治疗组(P＜0.05).重、中、轻度活动组及健康对照者组的IL-21、CXCL13水平依次降低(P均＜0.05).结论 RA患者外周血Tfh比例及IL-21、CXCL13水平显著升高,且与疾病活动、骨侵蚀等有明显相关,抗风湿药物治疗可以降低Tfh,提示Tfh细胞可能在RA发病中起着重要作用.
목적 통과검측류풍습관절염(RA)환자외주혈려포보조성T세포(Tfh)화세포인자백세포개소(IL)-21,CXCL13적표체병여건강자비교,탐토기여RA림상표현적상관성급기가능적면역학발병궤제.방법 류식세포의검측환자화건강대조외주혈중Tfh세포적변화；매련면역흡부시험( ELISA)법검측RA환자급건강대조자혈장중IL-21、CXCL13등세포인자적수평.채용t검험、단인소방차분석화SNK-q검험、z2검험、Spearman질화상관분석이급다원선성회귀분석.결과 RA환자외주혈중Tfh비례현저고우대조조(3.0±1.2여1.1±0.4,P＜0.01)；동시RA환자경、중、중도활동조외주혈Tfh적비례의차증다(1.8+0.7,2.5±0.6여4.0+1.2),3조지간비교차이균유통계학의의(P균＜0.01),차균교대조조승고(P＜0.01)；Tfh세포수여RA환자DAS28、홍세포침강솔(ESR)、C반응단백(CRP)、관절압통수、골질파배、RF급항배과안산태(CCP)항체적도정정상관；엄중골질파배조Tfh표체솔명현고우경도혹무골질파배조(2.7+1.1여3.4±1.3)；미치료조상비비정규치료조、정규치료조적Tfh표체솔축점강저(P균＜0.01)；정규치료조적Tfh표체솔저우비정규치료조(P＜0.05).중、중、경도활동조급건강대조자조적IL-21、CXCL13수평의차강저(P균＜0.05).결론 RA환자외주혈Tfh비례급IL-21、CXCL13수평현저승고,차여질병활동、골침식등유명현상관,항풍습약물치료가이강저Tfh,제시Tfh세포가능재RA발병중기착중요작용.
Objective To test the level of cell factor interleukin (IL)-21,CXCL13 in the plasma of patients with rheumatoid arthritis (RA),and to analyze the relationship between Follicular helper T cells(Tfh)and clinic features and discuss the possible immunological pathogenesis of RA.Methods The Tfh cells were obtained from patients and healthy controls (NC) and detected by Flow cytometery.While the levels of IL-21,CXCL13 in patients and NC were measured by ELISA tests.Those analysis were performed by student's t-test,one-way ANOVA,SNK-q test,Chi-square test,Spearman's correlation and multiple linear regression.Results The expression of CD4+CXCR5+ICOS+ cells (Tfh) in PBMCs of RA was significantly higher than normal controls (3.0±1.2 vs 1.1±0.4,P＜0.01).Meanwhile,the three RA groups of patients were divided to low,moderate and high disease activity groups,and the results showed that the expression of Tfh were increased accordingly (1.8±0.7,2.5±0.6,4.0±1.2).The expression of Tfh in the three groups were all significantly higher than that of controls (P＜0.01).There was a positive correlation between Tfh and DAS28,ESR,CRP,TJC,and bone erosion,RF and anti-CCP respectively.The expression of Tfh in those patients who had bone destruction was higher than those with no or mild bone destructions (2.7±1.1vs 3.4±1.3).The expression of Tfh in patients with un-treated RA patients,when compared to those RA patients who were treated appropriately and those who were not treated appropriately,was decreased significantly.The expression of Tfh in appropriately treated RA patients was lower than that without appropriately treatment.The level of IL-21,CXCL13 was decreased in patients with RA in the order of high,moderate,low disease activity and NC.Conclusion The expression of Tfh and the levels of IL-21,CXCL13 are increased significantly,and are closely related to disease activity and bone ersions.The expression of Tfh is decreased after relevant treatment.These results indicate that the abnormality of Tfh may play an important role in the pathogenesis of RA.