中华风湿病学杂志
中華風濕病學雜誌
중화풍습병학잡지
CHINESE JOURNAL OF RHEUMATOLOGY
2012年
7期
481-485
,共5页
岳涛%钮晓音%陈广洁%倪立青
嶽濤%鈕曉音%陳廣潔%倪立青
악도%뉴효음%진엄길%예립청
关节炎,类风湿%Th1细胞%重组抗肿瘤坏死因子-α人鼠嵌合单克隆抗体%Th17细胞%调节性T细胞
關節炎,類風濕%Th1細胞%重組抗腫瘤壞死因子-α人鼠嵌閤單剋隆抗體%Th17細胞%調節性T細胞
관절염,류풍습%Th1세포%중조항종류배사인자-α인서감합단극륭항체%Th17세포%조절성T세포
Arthritis,rheumatoid%Th1 cells%Anti-TNF rcMAb%Th17 cells%T regulatory cells
目的 研究重组抗肿瘤坏死因子-α(TNF-α)人鼠嵌合单克隆抗体(anti-TNF rcMAb)对类风湿关节炎(RA)患者治疗效果及对患者外周血Th1、Th17、调节性T细胞影响.方法 50例经严格筛选的RA患者按随机分配原则分为2组.联合治疗组(40例),给予anti-TNF rcMAb(3 mg/kg)+甲氨蝶呤治疗;对照组(10例)单独接受甲氨蝶呤治疗,分别于0、2、6、14周给药,于0、18周分别观察联合治疗组与对照组的相关临床指标的变化,在相应观察点做ACR20、50、70评分.同时,对比外周血中Th1、Th17、调节性T细胞的表达情况及相关转录因子T-bet、维甲酸相关孤核受体(ROR)C、叉头状转录因子3(Foxp3)的mRNA表达水平变化.采用t检验和x2检验或Ridit作统计学分析.结果 治疗前后,联合治疗组ACR20、50、70较对照组均有所改善,尤其ACR20改善程度与对照组相比,差异有统计学意义(Z=1.671,P=0.000 94).联合治疗组患者外周血Th17细胞无显著变化[(0周(1.1±0.6)％;18周(1.1±0.3)％]、Th1细胞比例降低[0周(7.1±3.9)％;18周(4.2±2.8)％],调节性T细胞比例明显升高[0周(91.5±0.8)％;18周(3.0±0.6)％,t=2.301,P=0.048];对照组Th1比例下降[0周(9.1±3.1)％;18周(5.8±2.6)％],调节性T细胞比例略升高[0周(1.2±0.6％);18周(2.2±0.6)％].2组Th17、Th1细胞的转录因子RORC、T-bet mRNA表达水平降低,调节性T细胞转录因子Foxp3的表达水平均升高.结论 anti-TNF rcMAb联合甲氨蝶呤治疗对RA患者疗效显著,可能通过影响患者外周血Th细胞亚群发挥其治疗作用.
目的 研究重組抗腫瘤壞死因子-α(TNF-α)人鼠嵌閤單剋隆抗體(anti-TNF rcMAb)對類風濕關節炎(RA)患者治療效果及對患者外週血Th1、Th17、調節性T細胞影響.方法 50例經嚴格篩選的RA患者按隨機分配原則分為2組.聯閤治療組(40例),給予anti-TNF rcMAb(3 mg/kg)+甲氨蝶呤治療;對照組(10例)單獨接受甲氨蝶呤治療,分彆于0、2、6、14週給藥,于0、18週分彆觀察聯閤治療組與對照組的相關臨床指標的變化,在相應觀察點做ACR20、50、70評分.同時,對比外週血中Th1、Th17、調節性T細胞的錶達情況及相關轉錄因子T-bet、維甲痠相關孤覈受體(ROR)C、扠頭狀轉錄因子3(Foxp3)的mRNA錶達水平變化.採用t檢驗和x2檢驗或Ridit作統計學分析.結果 治療前後,聯閤治療組ACR20、50、70較對照組均有所改善,尤其ACR20改善程度與對照組相比,差異有統計學意義(Z=1.671,P=0.000 94).聯閤治療組患者外週血Th17細胞無顯著變化[(0週(1.1±0.6)％;18週(1.1±0.3)％]、Th1細胞比例降低[0週(7.1±3.9)％;18週(4.2±2.8)％],調節性T細胞比例明顯升高[0週(91.5±0.8)％;18週(3.0±0.6)％,t=2.301,P=0.048];對照組Th1比例下降[0週(9.1±3.1)％;18週(5.8±2.6)％],調節性T細胞比例略升高[0週(1.2±0.6％);18週(2.2±0.6)％].2組Th17、Th1細胞的轉錄因子RORC、T-bet mRNA錶達水平降低,調節性T細胞轉錄因子Foxp3的錶達水平均升高.結論 anti-TNF rcMAb聯閤甲氨蝶呤治療對RA患者療效顯著,可能通過影響患者外週血Th細胞亞群髮揮其治療作用.
목적 연구중조항종류배사인자-α(TNF-α)인서감합단극륭항체(anti-TNF rcMAb)대류풍습관절염(RA)환자치료효과급대환자외주혈Th1、Th17、조절성T세포영향.방법 50례경엄격사선적RA환자안수궤분배원칙분위2조.연합치료조(40례),급여anti-TNF rcMAb(3 mg/kg)+갑안접령치료;대조조(10례)단독접수갑안접령치료,분별우0、2、6、14주급약,우0、18주분별관찰연합치료조여대조조적상관림상지표적변화,재상응관찰점주ACR20、50、70평분.동시,대비외주혈중Th1、Th17、조절성T세포적표체정황급상관전록인자T-bet、유갑산상관고핵수체(ROR)C、차두상전록인자3(Foxp3)적mRNA표체수평변화.채용t검험화x2검험혹Ridit작통계학분석.결과 치료전후,연합치료조ACR20、50、70교대조조균유소개선,우기ACR20개선정도여대조조상비,차이유통계학의의(Z=1.671,P=0.000 94).연합치료조환자외주혈Th17세포무현저변화[(0주(1.1±0.6)％;18주(1.1±0.3)％]、Th1세포비례강저[0주(7.1±3.9)％;18주(4.2±2.8)％],조절성T세포비례명현승고[0주(91.5±0.8)％;18주(3.0±0.6)％,t=2.301,P=0.048];대조조Th1비례하강[0주(9.1±3.1)％;18주(5.8±2.6)％],조절성T세포비례략승고[0주(1.2±0.6％);18주(2.2±0.6)％].2조Th17、Th1세포적전록인자RORC、T-bet mRNA표체수평강저,조절성T세포전록인자Foxp3적표체수평균승고.결론 anti-TNF rcMAb연합갑안접령치료대RA환자료효현저,가능통과영향환자외주혈Th세포아군발휘기치료작용.
Objective To explore the effect of anti-TNF rcMAb in the treatment of patients with rheumatoid arthritis (RA) and its effect on peripheral blood Th1,Th17 and Treg cells.Methods Fifty rigorously screened RA patients were randomly divided to the therapy group (n=40) who received the combined treatment of anti-TNF rcMAb and MTX,and control group (n=10) who were given MTX along with placebo,both at week 0,2,6,and 14.The clinical data of the two groups were observed and accessed respectively at week 0 and 18.In addition,the percentage of Th1,Th17,Treg cells in the peripheral blood and the relative gene expressions of transcription factors T-bet,RORC,Foxp3 in these patients were also observed respectively before and after treatment.We used t inspection and x2 inspection as the statistical analysis methods in conducting this study.Results Comparing with the control group,more patients achieved ACR20,ACR50 and ACR70 response in the combined therapy group (Z=1.671,P=0.000 94).The percentage of peripheral blood Th1 cells decreased [week 0:(7.1±3.9)％; week 18:(4.2±2.8)％] and the percentage of Treg cells obviously increased [week 0:(1.5±0.8)％; week 18:(3.0±0.6)％,t=2.301,P=0.048] in the combined therapy recipients,while the percentage of Th1 cells fell [week 0:(9.1±3.1)％; week 18:(5.8±2.6)％] and that of Treg cells slightly increased [week 0:(1.2±0.6)％; week 18:(2.2±0.6)％] in the controls.The mRNA expressions of RORC and T-bet,the transcription factors of Th17 and Th1,were decreased respectively and that of Foxp3,the transcription factor of Treg,were elevated in both groups.Conclusion The combined therapy of anti-TNF rcMAb and MTX is very effective in RA patients.Good outcome is likely achieved by modifying the peripheral blood Th cell subsets in patients with RA.
