类风湿关节炎患者外周血Th细胞亚群的变化及依那西普的调节作用  

Functional status of T helper cells in rheumatoid arthritis and effect of etanercept

作　　者：吕婷婷[1] 朱平[1] 李晓燕[1] 樊春梅[1] 

机构地区：[1]第四军医大学西京医院临床免疫科,陕西西安710032

出　　处：《细胞与分子免疫学杂志》2008年第5期495-497,共3页Chinese Journal of Cellular and Molecular Immunology

基　　金：国家自然科学基金资助项目(30530720)

摘　　要：目的:观察活动期类风湿关节炎(RA)患者外周血中辅助性T细胞亚群(Th1、Th2和Th17)数量和比例的变化,探讨依那西普治疗对Th亚群的作用。方法:选择20例活动期中重度RA患者,随机分为依那西普加MTX联合治疗组、MTX治疗组,于治疗前后分离PBMC,采用流式细胞术(FCM)检测Th1、Th2、Th17细胞的数量及Th1/Th2比值,同步用ELISA测定培养上清中IFN-γ、IL-4、IL-17水平,与同期选择的健康对照组比较并与患者的病情活动指标进行相关性分析。结果:治疗前活动期RA患者PBMC中IFN-γ+Th1细胞的量、IL-17+Th17细胞的量及平均荧光强度、Th1/Th2比值均高于健康对照组[(27.0±2.9)%vs(23.2±1.7)%,P<0.05;(36.78±2.6)%vs(2.35±0.9)%及(26.61±2.6)vs(11.4±1.2),P<0.01;(12.8±1.6)vs(8.60±1.9),P<0.01];依那西普加MTX联合治疗12周后,RA患者的病情改善,IFN-γ+Th1细胞、Th1/Th2比值、IL-17+Th17细胞的量及平均荧光强度、培养上清中IL-17水平均低于治疗前,而与健康对照组相比无统计学意义(P>0.05),且联合治疗组降低的幅度均大于MTX治疗组;治疗前后Th17细胞的量与C反应蛋白(CRP)、疾病活动指数(DAS28)的消长呈正相关(P<0.05,r=0.38和P<0.05,r=0.42)。结论:IL-17+Th17细胞、IFN-γ+Th1细胞及Th1/Th2比值的增高可能参与活动期RA的发病机制,依那西普治疗可改善RA病情并下调Th1和Th17细胞亚群。AIM： To ascertain the effect of etanercept treatment on the T-helper cells subsets （including Th1, Th2, Th1T） in rheumatoid arthritis （RA）. METHODS： 20 RA patients and 10 age-matched healthy people were studied. The expression of IL-4, IFN-γ and IL-17 on lymphocyte （CD4^＋ ） of RA patients peripheral blood were assessed by flow cytometry; Production of IFN-γ, IL-4 and IL-17 were measured by enzyme-linked immunosorbent assay（ELISA） in RA sera pre- and post-12 weeks of therapy and that of 10 normal health controls were studied; correlations between percentage of IFN-γ Th1, IL-17^＋ Th17, value of Th1/Th2 and clinical factors were observed in RA. RESULTS： The percentage of Th1 and Th17, intensity of Th17 and value of Th1/Th2 were higher than the healthy controls （ P 〈 0.05 ） ; After etanercept treatment the percentage and intensity of Th17 were significantly decreased （ P 〈 0. 01 ）, as well as the percentage of Th1 and value of Th1/Th2 （ P 〈 0.05 ）, level of IL-17 decreased significantly but IFN-γ, IL-4 had no significant difference; The percentage of IL-17^＋ Th17 on CD4^＋ T cells correlate positively to CRP and DAS28. CONCLUSION： Th17 cells may play a role in the pathogenesis of RA, the down regulation of Th17 and Th1/Th2 is significant for the evaluation of the curative effect of etanercept.

关 键 词：关节炎 类风湿 流式细胞术 依那西普 TH亚群 TH17细胞 

分 类 号：R392.12[医药卫生—免疫学]