幼年特发性关节炎免疫功能及其临床应用价值  

Exploration of immune function and its clinical significance in children with juvenile idiopathic arthritis

作　　者：丁艳[1] 王瑞耕[1] 孙东明[1] 夏琨[1] 尹薇[1] 

机构地区：[1]武汉市儿童医院风湿免疫科,430016

出　　处：《中华实用儿科临床杂志》2014年第21期1643-1647,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：武汉市卫生局临床重点专科研究项目（200743）

摘　　要：目的分析幼年特发性关节炎（JIA）及其不同亚型的细胞及体液免疫特征，探讨细胞免疫及体液免疫功能在JIA发病机制中的作用及临床应用价值。方法应用流式细胞仪免疫荧光法检测92例JIA患儿和82例健康对照儿童的T淋巴细胞亚群、自然杀伤（NK）细胞、B淋巴细胞变化，酶联免疫吸附试验（ELISA）法检测血清白细胞介素1（IL-1）、肿瘤坏死因子α（TNF—α）、IL-10、转化生长因子-β（TGF—β）水平，速率散射比浊法检测免疫球蛋白IgG、IgM、IgA及补体C3、C4水平。采用独立样本t检验、One—WayANOVA和Pearson检验行数据分析。结果1．与对照组相比，JIA组CD3、CD4、IL-1、TNF-α、IgG、IgM、IgA、C3水平均升高（P均〈0．05），CD4CD25、CD8、NK细胞、IL-10、TGF—β水平均降低（P均〈0．05），CD4／CD8比值升高（P〈0．05）。2．全身型JIACIM水平、CD4／CD8比值、IL-1、TGF—β、IgG、IgM、IgA、C3、C4水平高于少关节型（P均〈0．05），CD4CD25、CD8、IL-10水平低于少关节型（P均〈0．05），多关节型IL-1、TNF—α、IgG、IgM、IgA水平高于少关节型（P均〈0．05），CD4CD。CD8、IL-10水平低于少关节型（P均〈0．05），全身型CD4、TGF-β、C3、C4水平高于多关节型（P均〈0．05）。3．JIA组IL—1、TNF-α与C反应蛋白（CRP）、红细胞沉降率（ESR）呈正相关（P均〈0．05），IL-10、TGF—β与CRP、ESR呈负相关（P均〈0．05）。结论JIA存在细胞及体液免疫功能的紊乱，参与了JIA的发病机制，表现为T辅助细胞功能活化，Thl类细胞网子增加，抑制性T淋巴细胞及调节性T淋巴细胞功能减低，抑制性细胞因子降低，免疫球蛋白水平增加，介导了JIA的自身炎性反应及关节骨质的破坏，其中全身型和多关节型免疫紊乱更为显著；IL-1、TNF-α、IL-10、TGF—β与病情活动度相关。Objective To analyze the changes of eelluar and humoral immunity in children with juvenile idiopathic arthritis （JIA） , as well as the changes in different subtypes, and to investigate the role of cellular and humoral immunity in the pathogenesis of JIA. Methods Ninety-two JIA subjects and 82 controls（healthy children） were included into this study. The levels of T lymphocyte subsets, natural killer （NK）cells, and B cells were analyzed by using flow cytometry. The serum interleukin-1 （ IL-1 ） , tmnor necrosis factor-α （ TNF-α ）, interleukin-10 （ IL-10 ）, transforming growth factor-β（TGF-β） levels were detected by using enzyme-linked immunosorbent assay （ELISA）. The serum IgG, IgM,IgA and C3, C4 levels were detected by using velocity scatter turbidimetry. Independent t-test, One-Way ANOVA test and Pearson analysis were adopted for data analysis. Results 1. In the group of JIA,the levels of CD3, CIM,IL-1, TNF-α,IgG, IgM, IgA and C3 were higher than those in the control group （all P 〈 0.05 ） ,while the levels of CD4CD25, CDS, NK cells, IL-10 and TGF-g3 were lower than those in the control group（ all P 〈 0.05 ） , and the ratio of CD4/CD8 was higher than that in the control group （ P 〈 0.05 ）. 2. In the group of systemic-onset JIA （so-JIA） , the levels of CIM, IL-1 , TGF-β, IgG, IgM, IgA, C3 and the ratio of CD4/CD8 were higher than those in the oligoarthritis JIA group （ all P 〈 0.05 ）, while the levels of CD4CD25, CD8, IL-10 were lower than those in the oligoarthritis JIA group（ all P 〈 0.05 ）. In the group of polyarthritis JIA,the levels of IL-1 ,TNF-α, IgG, IgM and IgA were higher than those in the oligoarthritis JIA group（ all P 〈 0.05 ） ,while the levels of CD4CD25, CD8, IL-10 were lower than those in the oligoarthritis JIA group （ all P 〈0. 05 ） ; In the group of so-JIA,the levels of CD4,TGF-β, C3 and C4 were higher than those in the polyarthritis JIA group（ all P 〈 0.05 ）. 3. The value of IL-1 ,TNF-α were positively co

关 键 词：关节炎 幼年型类风湿 T淋巴细胞亚群 B淋巴细胞 细胞因子 

分 类 号：R725.9[医药卫生—儿科]