CAJ | 학술논문

目的探讨类风湿关节炎(RA)患者外周血Th17表达的水平对早期发现缓解期患者关节侵蚀的意义.方法选择无关节破坏的活动性RA患者41例,分别在基线及系统治疗24个月时,采用流式细胞术检测外周血Th17表达,同步用ELISA法测定血清白细胞介素(IL)-17A水平,并与患者的病情活动性评价指标(DAS28)进行相关性分析.设30名健康体检者为健康对照组.系统治疗24个月时,将所有患者根据Sharp/van der Heijde评分(SHS)分为关节侵蚀组(P组,10例)(SHS ＞0.5)和无关节侵蚀组(NP组,26例)(SHS≤0.5),比较两者外周血Th17及IL-17A水平.结果活动期RA患者的Th17表达明显高于健康对照组[(1.63±0.45)％比(0.91±0.26)％,P＜0.01],Th17表达水平与DAS28评分呈正相关(r=0.87,P＜0.叭);RA患者IL-17A水平亦明显高于健康对照组[1510±280)ng/L比(320±31) ng/L,P＜0.05].进入观察终点的36例患者系统治疗24个月时按DAS28缓解标准均已达到临床缓解(DAS28 ＜2.6),P组的Th17表达高于NP组,两组的外周血IL-17A水平差异无统计学意义.结论部分RA患者在达到临床缓解后仍可持续出现结构破坏,外周血Th17高水平对缓解期患者的关节侵蚀有提示意义.
목적 탐토류풍습관절염(RA)환자외주혈Th17표체적수평대조기발현완해기환자관절침식적의의.방법 선택무관절파배적활동성RA환자41례,분별재기선급계통치료24개월시,채용류식세포술검측외주혈Th17표체,동보용ELISA법측정혈청백세포개소(IL)-17A수평,병여환자적병정활동성평개지표(DAS28)진행상관성분석.설30명건강체검자위건강대조조.계통치료24개월시,장소유환자근거Sharp/van der Heijde평분(SHS)분위관절침식조(P조,10례)(SHS ＞0.5)화무관절침식조(NP조,26례)(SHS≤0.5),비교량자외주혈Th17급IL-17A수평.결과 활동기RA환자적Th17표체명현고우건강대조조[(1.63±0.45)％비(0.91±0.26)％,P＜0.01],Th17표체수평여DAS28평분정정상관(r=0.87,P＜0.팔);RA환자IL-17A수평역명현고우건강대조조[1510±280)ng/L비(320±31) ng/L,P＜0.05].진입관찰종점적36례환자계통치료24개월시안DAS28완해표준균이체도림상완해(DAS28 ＜2.6),P조적Th17표체고우NP조,량조적외주혈IL-17A수평차이무통계학의의.결론 부분RA환자재체도림상완해후잉가지속출현결구파배,외주혈Th17고수평대완해기환자적관절침식유제시의의.
Objective To explore the significance and evaluate the early structural erosion through the expressions of Th17 cells in peripheral blood of patients with rheumatoid arthritis (RA) in clinical remission.Methods A total of 41 active RA patients without structural erosion were selected.Intracelluar flow cytometric detection of Th17 cells in peripheral blood was performed.And the supernatant level of interleukin (IL)-17A was determined simultaneously in RA patients and control groups at baseline and endpoint of 24-month therapy.The correlations were analyzed between Th17 cells and RA disease activity index DAS28.They were classified into radiographic progression (P,n =10) and radiographic nonprogression groups (NP,n =26) by the Sharp/van der Heijde score (SHS) at the endpoint.The differences of Th17 cells and IL-17A levels were analyzed between P (SHS ＞ 0.5) and NP groups (SHS ≤ 0.5).Results The expression of Th17 cells in active RA patients was significantly higher than that of controls [(1.63 ± 0.45)％ vs (0.91 ± 0.26) ％,P ＜ 0.0 1].And the results of IL-17A level were similar [1510 ± 280) vs (320 ±31) ng/L,P＜0.05].The expression of Th17 cells was positively correlated with DAS28 score (r =0.87,P ＜ 0.01).Thirty-six RA patients were followed up at the endpoint and all of them stayed in clinical remission (DAS28 ＜ 2.6).The peripheral blood expressions of Th17 cells of P group were significantly higher than those of NP group.At the same time,no differences of IL-17A levels existed between two groups.Conclusion Structural erosion still progresses in some RA patients despite an apparent clinic remission.And a high-level peripheral expression of Th17 hints at structural erosion.