幼年类风湿关节炎患儿血清白介素-15变化与T_H细胞亚群表达的研究  

Levels of serum interleukin-15 and the expression of T-helper lymphocyte subsets inperipheral blood of children with juvenile rheumatoid arthritis

作　　者：曹兰芳[1] 卢燕鸣[1] 马敏[1] 薛海燕[1] 赵瑜[1] 余汉卿[1] 毛海英[1] 顾越英[1] 

机构地区：[1]上海第二医科大学附属仁济医院儿科,上海200001

出　　处：《中国当代儿科杂志》2006年第1期9-12,共4页Chinese Journal of Contemporary Pediatrics

摘　　要：目的探讨幼年类风湿关节炎(JRA)患儿血清白介素15变化及其TH细胞亚群CD4+CD45RA+,CD4+CD45RO+的表达变化。方法采用ELISA方法检测39例JRA患儿的血清IL15的水平,并同期选择26例年龄、性别无差异的健康儿童为对照。对其中24例JRA患儿采用免疫荧光标记技术和流式细胞仪检测外周血CD4+T淋巴细胞亚群CD4+CD45RA+,CD4+CD45RO+的表达。结果JRA患儿组血清IL15水平显著高于正常对照组(P<0.05);JRA常见亚型中全身型患儿血清IL15水平明显升高,与对照组比较差异有显著性(P<0.01),而少关节型、多关节型患儿IL15水平与对照组比较差异无显著性(P>0.05);治疗后IL15水平较治疗前明显下降(P<0.01);JRA患儿血清IL15水平与外周血白细胞计数呈正相关(r=0.347,P<0.05),与血沉无相关(r=0.307,P>0.05),与C反应蛋白呈显著正相关(r=0.452,P<0.01);IL15高表达组患儿外周血CD4+CD45RO+T淋巴细胞数明显高于IL15低表达组患儿(P<0.05),CD4+CD45RA+T淋巴细胞数、CD4+CD45RA+T/CD4+CD45RO+T比值略低于IL15低表达组患儿,差异无显著性(P>0.05)。结论JRA患儿血清IL15的水平显著升高;IL15升高使JRA患儿外周血CD4+T细胞表面CD45RA分子向CD45RO分子转换,促使T淋巴细胞大量激活,进而介导组织免疫病理损伤;在临床上可通过检测IL15以判断JRA的病情状况,为JRA治疗提供理论依据。Objective To study the changes of serum interleukin-15 （IL-15） levels and the expression of CD4^＋ T（Thelper lymphocyte） subsets CD4^＋ CIM5RA^＋ and CD4^＋ CIM5RO^＋ in peripheral blood of children with juvenile rheumatoid arthritis （JRA）. Methods The serum concentration of IL-15 was detected using ELISA in 39 children with JRA. The expressions of CD4^＋ CD45RA^＋ T and CD4^＋ CIM5RO^＋ T in peripheral blood were detected by flow cytometry in 24 out of the 39 patients with JRA. Twenty-six age and sex-matched healthy children were used as the Control group. Results The mean serum IL-15 level in JRA patients was significantly higher than that in controls （ 1.37±0.98 pg/mL vs 0.96±0.41 pg/mL, P 〈 0. 05 ）. Among the 39 JRA patients, the serum IL-15 level in 17 patients with systemic JRA increased remarkably（ P 〈0.01 ）, but not in patients with the other two types of JRA, the oligoarthritis and polyarthritis （ n = 13, n =9, respectively）, compared with that in controls. The mean serum IL-15 level of the JRA patients was significantly reduced after conventional treatment （P 〈 0.01 ）. The serum IL-15 level in JRA patients positively correlated with white blood cell count（ r = 0. 347, P 〈 0. 05 ） and C reactive protein （ r = 0. 452, P 〈 0.01 ）, but not with the erythrocyte sedimentation rate. The patients with high serum IL-15 levels （≥medium level 1.73 pg/mL） had higher expression of CD4^＋ CIM5RO^＋ T than those with low serum IL-15 levels （ 〈medium level） （16.29±5.46% vs 11.75±3.15 % ,P〈0.05）. Conclusions The serum IL-15 levels in JRA patients increased significantly. An increased IL-15 level can transform CD45RA into CD45RO in peripheral blood of patients with JRA, and then result in T lymphocyte activation and mediate the immunopathological impairment. IL- 15 may be used a marker for the evaluation of severity of JRA.

关 键 词：幼年类风湿关节炎 白介素-15 TH淋巴细胞 CD4^+CD45RA CD4^+CD45RO 儿童 

分 类 号：R725.9[医药卫生—儿科]