英夫利西诱导活动期克罗恩病临床缓解对白细胞介素-21及其受体水平的影响  

Effects of infliximab induced clinical remission of active Crohn＇s disease on the level of interleukin-21 and interleukin-21 receptor

作　　者：黄培新[1] 陈腾飞[1] 刘嫦钦[1] 邬瑞金[1] 刘占举[1] 

机构地区：[1]同济大学附属第十人民医院消化内科,上海200072

出　　处：《中华消化杂志》2012年第9期629-631,共3页Chinese Journal of Digestion

基　　金：国家自然科学基金（30971358）

摘　　要：目的探讨克罗恩病（CD）患者接受英夫利西（IFX）治疗前后IL-21及其受体（IL-21R）表达水平的变化并分析其临床意义。方法收集2009年6月至2011年7月同济大学附属第十人民医院符合研究标准的22例CD患者，分别在第0、2、6周时给予IFX治疗。以同期16例健康体检者为健康对照组。健康对照组于体检时、CD患者于治疗开始前和治疗第10周时取静脉血，并经结肠镜检查取肠黏膜活组织检查标本。观察CD患者克罗恩病活动指数（CDAI）、ESR、C反应蛋白（CRP）的变化。使用流式细胞仪分析外周血CD4＋T淋巴细胞IL-21R表达水平变化。使用荧光定量PCR方法分析肠黏膜组织内IL-21mRNA表达水平变化。数据处理采用t检验。结果治疗前，CD患者外周血CD4＋T淋巴细胞IL-21R表达水平（12．25％±3．25%）和肠黏膜组织内IL-21mRNA表达水平（1．38±0．32）均明显高于健康对照者（分别为4．25％土1．41％和0．44±0．18），差异均有统计学意义（F=15．88、6．75，P值均〈O．05）。第10周时，CD患者外周血CD4＋T淋巴细胞IL-21R表达水平（8．12%±2．05％）和肠黏膜组织内IL-21mRNA表达水平（0．77±0．24）均明显低于治疗前，差异均有统计学意义（t=4．880、8．019，P值均〈O．01）。治疗前，CD患者的ESR、CRP和CDA1分别为（46．8±11．4）mm／1h、（52．4±11．5）mg／L、319±74，治疗后则分别为（23．5土9．0）mm／1h、（11．6±4．6）mg／L、113±42，差异均有统计学意义（t=9．485、16．458、11．100，P值均〈0．05）。结论活动期CD患者经IFX治疗后IL-21表达水平下降，提示IL-21可能参与IFX诱导活动期CD临床缓解。Objective To investigate the changes of interleukin-21 （IL-21） and interleukin-21 receptor （IL-21R） expression level in Crohn＇s disease （CD） patients before and after accepted infliximab （IFX） treatment. Methods From June 2009 to July 2011, twenty-two CD patients met the research criteria were recruited at Tenth People＇s Hospital of Tongji University. Patients were treated with infliximab at weeks 0, 2, 6, and 16 healthy individuals were set as healthy control group at same time. Peripheral blood of healthy control group was taken at regular physical examination and blood of CD patients was taken before treatment and 10 weeks after treatment, intestinal mucosa biopsy samples were taken under colon endoscopy examination. The changes of Crohn＇s disease activity index （CDAI）, erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP） in CD patients were observed. The change of IL-21R in peripheral blood CD4＋ T lymphocytes was detected by flow cytometry. The change of IL-21 expression at mRNA level in intestinal mucosa was determined by realtime quantitative polymerase chain reaction （PCR）. The data were analyzed by t test. Results Before treatment, the level of IL-21R in peripheral blood CD4＋ T lymphocytes of CD patients （12.25%±3.25%） and the expression of IL-21 at mRNA level in inflamed intestinal mucosa （1.38± 0.32） were both significantly higher than those of healthy controls （4.25%±1.41%, 0. 44±0.18）, the differences were statistically significant （F= 15.88, 6.75; both P〈0.05）. At 10th week, the level of IL-21R in peripheral blood CD4＋ T lymphocytes of CD patients （8. 12%± 2. 05%） and the expression of IL-21 at mRNA level in intestinal mueosa （0.77 ±0.24） were both significantly lower than those before treatment, the differences were statistically significant （ t=4. 880, 8. 0193 both P〈 0.01）. Before treatment, ESR, CRP and CDAI of CD patients was （46.8±11.4） mm/1 h, （52.4±11.5） mg/L and 319±74, which was （23.5±9

关 键 词：克罗恩病 抗肿瘤坏死因子 白细胞介素类 受体 白细胞介素-21 

分 类 号：R574.62[医药卫生—消化系统]