CAJ | 학술논문

目的探讨克罗恩病(CD)患者接受英夫利西(IFX)治疗前后IL-21及其受体(IL-21R)表达水平的变化并分析其临床意义.方法收集2009年6月至2011年7月同济大学附属第十人民医院符合研究标准的22例CD患者,分别在第0、2、6周时给予IFX治疗.以同期16例健康体检者为健康对照组.健康对照组于体检时、CD患者于治疗开始前和治疗第10周时取静脉血,并经结肠镜检查取肠黏膜活组织检查标本.观察CD患者克罗恩病活动指数(CDAI)、ESR、C反应蛋白(CRP)的变化.使用流式细胞仪分析外周血CD4+T淋巴细胞IL-21R表达水平变化.使用荧光定量PCR方法分析肠黏膜组织内IL-21 mRNA表达水平变化.数据处理采用t检验.结果治疗前,CD患者外周血CD4+T淋巴细胞IL-21R表达水平(12.25％±3.25％)和肠黏膜组织内IL-21mRNA表达水平(1.38±0.32)均明显高于健康对照者(分别为4.25％±1.41％和0.44±0.18),差异均有统计学意义(F=15.88、6.75,P值均＜0.05).第10周时,CD患者外周血CD4+T淋巴细胞IL-21R表达水平(8.12％±2.05％)和肠黏膜组织内IL-21 mRNA表达水平(0.77±0.24)均明显低于治疗前,差异均有统计学意义(t=4.880、8.019,P值均＜0.01).治疗前,CD患者的ESR、CRP和CDAI分别为(46.8±11.4) mm/1 h、(52.4±11.5) mg/L、319±74,治疗后则分别为(23.5±9.0)mm/1 h、(11.6±4.6) mg/L、113±42,差异均有统计学意义(t=9.485、16.458、11.100,P值均＜0.05).结论活动期CD患者经IFX治疗后IL-21表达水平下降,提示IL-21可能参与IFX诱导活动期CD临床缓解.
목적 탐토극라은병(CD)환자접수영부리서(IFX)치료전후IL-21급기수체(IL-21R)표체수평적변화병분석기림상의의.방법 수집2009년6월지2011년7월동제대학부속제십인민의원부합연구표준적22례CD환자,분별재제0、2、6주시급여IFX치료.이동기16례건강체검자위건강대조조.건강대조조우체검시、CD환자우치료개시전화치료제10주시취정맥혈,병경결장경검사취장점막활조직검사표본.관찰CD환자극라은병활동지수(CDAI)、ESR、C반응단백(CRP)적변화.사용류식세포의분석외주혈CD4+T림파세포IL-21R표체수평변화.사용형광정량PCR방법분석장점막조직내IL-21 mRNA표체수평변화.수거처리채용t검험.결과 치료전,CD환자외주혈CD4+T림파세포IL-21R표체수평(12.25％±3.25％)화장점막조직내IL-21mRNA표체수평(1.38±0.32)균명현고우건강대조자(분별위4.25％±1.41％화0.44±0.18),차이균유통계학의의(F=15.88、6.75,P치균＜0.05).제10주시,CD환자외주혈CD4+T림파세포IL-21R표체수평(8.12％±2.05％)화장점막조직내IL-21 mRNA표체수평(0.77±0.24)균명현저우치료전,차이균유통계학의의(t=4.880、8.019,P치균＜0.01).치료전,CD환자적ESR、CRP화CDAI분별위(46.8±11.4) mm/1 h、(52.4±11.5) mg/L、319±74,치료후칙분별위(23.5±9.0)mm/1 h、(11.6±4.6) mg/L、113±42,차이균유통계학의의(t=9.485、16.458、11.100,P치균＜0.05).결론 활동기CD환자경IFX치료후IL-21표체수평하강,제시IL-21가능삼여IFX유도활동기CD림상완해.
Objective To investigate the changes of interleukin-21 (IL 21) and interleukin-21 receptor (IL 21R) expression level in Crohn's disease (CD) patients before and after accepted infliximab (IFX) treatment.Methods From June 2009 to July 2011,twenty-two CD patients met the research criteria were recruited at Tenth People's Hospital of Tongji University.Patients were treated with infliximab at weeks 0,2,6,and 16 healthy individuals were set as healthy control group at same time.Peripheral blood of healthy control group was taken at regular physical examination and blood of CD patients was taken before treatment and 10 weeks after treatment,intestinal mucosa biopsy samples were taken under colon endoscopy examination.The changes of Crohn's disease activity index (CDAI),erythrocyte sedimentation rate (ESR),C-reactive protein (CRP) in CD patients were observed.The change of IL-21R in peripheral blood CD4+ T lymphocytes was detected by flow cytometry.The change of IL-21 expression at mRNA level in intestinal mucosa was determined by realtime quantitative polymerase chain reaction (PCR).The data were analyzed by t test.Results Before treatment,the level of IL21R in peripheral blood CD4+ T lymphocytes of CD patients (12.25％±3.25％) and the expression of IL-21 at mRNA level in inflamed intestinal mucosa (1.38±0.32) were both significantly higher than those of healthy controls (4.25 ％ ± 1.41％,0.44±0.18),the differences were statistically significant (F=15.88,6.75 ; both P＜0.05).At 10th week,the level of IL-21R in peripheral blood CD4+ T lymphocytes of CD patients (8.12％ ± 2.05％) and the expression of IL-21 at mRNA level in intestinal mucosa (0.77 ± 0.24) were both significantly lower than those before treatment,the differences were statistically significant ( t=4.880,8.019; both P＜0.01).Before treatment,ESR,CRP and CDAI of CD patients was (46.8±11.4) mm/1 h,(52.4±11.5) mg/L and 319±74,which was (23.5±9.0) mm/1 h,(11.6±4.6) mg/L and 113±42 after treatment,the differences were statistically significant (t=9.485,16.458,11.100; all P＜0.05).Conclusion The IL-21 expression of active CD patients decreases after IFX treatment,which indicates that IL-21 may involve in IFX induced clinical remission of active CD.