人细小病毒B19感染与类风湿性关节炎发病的关联分析  

THE RELATIONSHIP OF HUMAN PARVOVIRUS B19 INFECTION WITH OCCURRENCE OF RHEUMATOID ARTHRITIS

作　　者：王清[1] 伦立民[1] 孙美玲[1] 王丽华[1] 贾红岩[1] 

机构地区：[1]山东青岛大学医学院附属医院检验科,青岛266003

出　　处：《现代预防医学》2010年第6期1112-1114,共3页Modern Preventive Medicine

基　　金：山东省卫生厅资助项目(2005hw022)

摘　　要：[目的]探讨人细小病毒B19(B19)感染导致类风湿性关节炎(RA)的机理及免疫因素在其中的作用。[方法]随机抽取住院RA患者56例为病例组,外伤和骨关节炎55例作为对照组,应用聚合酶链反应(PCR)对其血液和关节液标本进行B19-DNA检测。同时对另外31例RA病例和11例对照的骨髓标本也进行B19-DNA检测。应用酶联免疫吸附测定法(ELISA)对上述血液标本进行B19-VP2-IgM检测以及血清中的炎症细胞因子(CK)TNF-α,IL-1,IL-6,IL-8的检测。[结果]病例组血标本B19-DNA阳性19例(33.9%),关节液标本B19-DNA阳性20例(35.7%);B19-VP2-IgM阳性14例(25.0%)与对照组间差异均有统计学意义(血χ2=14.69,P﹤0.01,关节液χ2=14.69,P﹤0.01,B19-VP2-IgMχ2=10.272,P﹤0.05)。在56例RA中,12例B19-DNA、B19-VP2-IgM阳性,2例仅B19-VP2-IgM阳性,7例仅B19-DNA阳性,同时B19-DNA、B19-VP2-IgM阴性35例;一致率为83.9%(P﹥0.05)。RA患者31例骨髓标本中16例B19-DNA阳性,阳性率为51.6%,与对照组(9.1%)比较差异有统计学意义(χ2=4.284,P﹤0.05)。RA患者骨髓标本B19-DNA阳性率高于血清(χ2=4.313,P﹤0.05)和关节液(χ2=4.313,P﹤0.05)。病例组CK水平高于对照组,两组间差异具有统计学意义。病例组B19-DNA阳性和B19-DNA阴性间上述细胞因子水平的比较差异无统计学意义。[结论]RA患者有较高的B19病毒感染率,B19病毒与RA密切相关,但B19并非是导致RA的唯一因素,作为一种诱发刺激因素,与其他致病因素协同作用,导致部分患者免疫功能紊乱,从而导致RA的发生。[Objective] To investigate the relationship of human parvovirus B19 infection between Rheumatoid Arthritis and the role of immune response. [Methods] 56 patients with RA and 55 unrelated controls （51 trauma and 4 osteoarthritis） were enrolled. Anti-parvovirus B19 VP2 IgM （B19-V2-IgM） antibodies were detected in sera of patients with RA and controls by the enzyme immunoassay method. B19 DNA was measured in the sera and synovia of above patients and in bone marrow with RA and controls by polymerase chain reaction （PCR）. [Results] The prevalence of B19 infection was significantly increased in patients with RA compared with controls. The positive rate （33.9%） of B19-DNA in sera was significantly higher in RA patients than that in controls （5.5%）. The positive rate （35.7%） of B19-DNA in synovia was significantly higher in RA patients than that in controls （0%）. 14 （25.0%） of the 56 RA patients and 2 （3.6%） of the control group showed positive for B19- VP2-IgM （P﹤0.01）. In 56 RA patients, 12 were positive for both B19-DNA and B19-VP2-IgM, while 7 were only positive for B19-DNA and 2 B19-VP2-IgM, and 35 were negative for both B19-DNA and B19-VP2-IgM. Crude agreement between the detecting results of B19-DNA and B19-VP2-IgM was 83.9%, and they were significantly consistent （P﹥0.05）. The positive rate （51.6%） of B19-DNA in bone marrow was significantly higher in RA patients than that in controls too. Interleukin （IL） -1beta, IL-5, IL-6, IL-8, IL-10, tumour necrosis factor （TNF） -alpha were significantly higher in patients with RA compared with control groups （P﹤0.01）. [Conclusion] The prevalence of B19 infection was significantly higher in patients with RA than in controls. B19 infection may play a role in susceptibility to RA.

关 键 词：类风湿性关节炎 细小病毒B19 人类 细胞因子 聚合酶链反应 酶联免疫吸附测定 

分 类 号：R593.22[医药卫生—内科学]