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 淋巴细胞(Tfh))和白细胞介素-21(IL-21)等的表达，探讨其在 RA 发病过程中可能的免疫学发病机制。方法根据病情活动度不同将病例组分为轻、中、重度活动组(各30例)，健康对照组30例；流式细胞仪检测 RA 和健康对照组外周血单个核细胞(PBMCs)中 CD4-异硫氰酸荧光素(FITC)、CXCR5-藻红蛋白(PE)、ICOS-别藻蓝蛋白(APC)标记的 CD3+ CD4+ CXCR+、CD3+ CD4+ ICOS+及 CD3+ CD4+ CXCR+ICOS+ Tfh 百分率；酶联免疫吸附试验(ELISA)检测 IL-21、类风湿因子(RF-IgM)、抗环瓜氨酸肽(CCP)抗体(CCP-IgG)及红细胞沉降率(ESR)、C 反应蛋白(CRP)，分析其与 Tfh 的相关性。结果RA 轻、中、重度活动组患者外周血中 Tfh 百分率明显高于健康对照组(P <0.05)；Tfh百分率随着 RA 活动度的增加呈上升趋势，组间差异有统计学意义(P <0.05)；Tfh 细胞百分率与 RA 患者 ESR、CRP、RF 及抗CCP 抗体滴度呈正相关，差异有统计学意义(P <0.05)。结论RA 患者外周血 Tfh、IL-21、CRP、ESR、RF 及 CCP 水平明显升高，与疾病活动度等有明显相关性，提示 Tfh 细胞可能在 RA 发病中起着一定的作用。
목적：통과검측류풍습관절염(RA)환자외주혈려포보조성 T 림파세포(Tfh))화백세포개소-21(IL-21)등적표체，탐토기재 RA 발병과정중가능적면역학발병궤제。방법근거병정활동도불동장병례조분위경、중、중도활동조(각30례)，건강대조조30례；류식세포의검측 RA 화건강대조조외주혈단개핵세포(PBMCs)중 CD4-이류청산형광소(FITC)、CXCR5-조홍단백(PE)、ICOS-별조람단백(APC)표기적 CD3+ CD4+ CXCR+、CD3+ CD4+ ICOS+급 CD3+ CD4+ CXCR+ICOS+ Tfh 백분솔；매련면역흡부시험(ELISA)검측 IL-21、류풍습인자(RF-IgM)、항배과안산태(CCP)항체(CCP-IgG)급홍세포침강솔(ESR)、C 반응단백(CRP)，분석기여 Tfh 적상관성。결과RA 경、중、중도활동조환자외주혈중 Tfh 백분솔명현고우건강대조조(P <0.05)；Tfh백분솔수착 RA 활동도적증가정상승추세，조간차이유통계학의의(P <0.05)；Tfh 세포백분솔여 RA 환자 ESR、CRP、RF 급항CCP 항체적도정정상관，차이유통계학의의(P <0.05)。결론RA 환자외주혈 Tfh、IL-21、CRP、ESR、RF 급 CCP 수평명현승고，여질병활동도등유명현상관성，제시 Tfh 세포가능재 RA 발병중기착일정적작용。
Objective To investigate the percentages of T follicuLar helper cells (Tfh)and interleukin-21(IL-21)in the plasma of patients with rheumatoid arthritis,and the immunological mechanism of Tfh cells in the development of rheumatoid arthritis. Methods According to ACR and DAS28,patients with rheumatoid arthritis were divided into low,moderate and high activity group.The percentages of CD3 + CD4 + CXCR+ 、CD3 + CD4 + ICOS+ and CD3 + CD4 + CXCR+ ICOS+ Tfh cells were detected by Flow Cytometry.While the levels of IL-21 、RF-IgM and anti-CCP in plasma were measured by ELlSA test.The analysis was performed by t-test and Spearman′s correlation analysis.Results The expression of CD3 + CD4 + CXCR+ ICOS+ Tfh cells in PBMCs of rheu-matoid arthritis was significantly higher than that in the normal controls(P <0.05).Meanwhile the results of the three rheumatoid arthritis groups(low,moderate and high activity groups)showed that the expression of Tfh increased accordingly(P <0.05).The expression of Tfh in rheumatoid arthritis was positively related with the levels of IL-21 ,ESR,CRP,RF and anti-CCP respectively. Conclusion The expression of Tfh and IL-21 increases significantly and is closely related to the disease activity in rheumatoid ar-thritis.The results indicate that the abnormality of Tfh may play an important role in the pathogenesis of rheumatoid arthritis.