外周血辅助性T细胞17/调节性T细胞在特发性炎性肌病中的表达和意义  

The expression and significance of Th17 cell/regulatory T cells in peripheral blood of patients with idio-pathic inflammatory myopathy

作　　者：赵慧[1] 温鸿雁[1] 刘洋[1] 曹蕾[1] 段亚楠 郑晓娟 侯志清 李小峰[1] 魏荣[2] 王晨[2] 李晓君[3] 王军[3] 萨建[4] Zhao Hui;Wen Hongyan;Liu Yang;Cao Lei;Duan Ya＇nan;Zheng Xiaojuan;Hou Zhiqing;Li Xiaofeng;Wei Rong;Wang Chen;Li Xiaojun;Wang Jun;Sa Jian(Department of Rheumatology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院风湿免疫科,太原030001 [2]山西医科大学第二医院病理科,太原030001 [3]山西医科大学第二医院影像科,太原030001 [4]山西医科大学统计学教研室

出　　处：《中华风湿病学杂志》2018年第9期590-596,共7页Chinese Journal of Rheumatology

基　　金：山西省回国留学人员科研资助项目 （2017-119）山西省留学回国人员科技活动择优资助项目 （2017）山西省重点研发计划项目-社会发展方面 （201603D321074）

摘　　要：目的观察特发性炎性肌病患者外周血辅助性T细胞（Th）17/调节性T细胞水平的变化，并探讨其与临床指标、影像及病理资料的相关性。方法收集资料完整的IIM患者（85例）及健康对照组（70名），分析外周血Th17细胞、调节性T细胞水平及临床资料（发病年龄、性别、病程）、实验室资料[ESR、CRP、肌酸激酶（CK）及其同工酶CK-MB、LDH、α-羟基丁酸脱氢酶（HBDH）等]、影像及病理学资料。计量资料不服从正态分布采用中位数（四分位数）法进行统计描述；两样本比较采用Mann-Whitney U检验；变量间相关性采用Spearman秩相关分析。结果① IIM组外周血Th17细胞水平与健康对照组差异无统计学意义[6.18（3.42，13.65）个/μl与7.42（5.02，11.13）个/μl，Z=-0.382，P〉0.05]；IIM组外周血调节性T细胞水平低于健康对照组[21.25（12.48，35.67）个/μl与36.95（30.37，47.12）个/μl，Z=-5.390，P〈0.05]；Th17/调节性T细胞显著高于健康对照组[0.31（0.21，0.47）与0.18（0.14，0.31），Z=-3.822，P〈0.05]。② IIM组Th17细胞水平与CRP、ESR、CRP、CK-MB、LDH、HBDH均无明显相关性（P〉0.05）；IIM组调节性T细胞水平与CRP呈负相关（r=-0.279，P〈0.05），与ESR、CRP、CK-MB、LDH、HBDH无明显相关性（P〉0.05）。③根据是否存在重要脏器受累（包括心、脑、肾、肺、肝脏等）将IIM分为脏器受累组和非脏器受累组，脏器受累组调节性T细胞水平低于非脏器受累组[16.54（8.84，27.34）个/μl与24.87（14.44，43.37）个/μl，Z=-2.453，P〈0.05]，Th17/调节性T细胞高于非脏器受累组[0.41（0.29，0.68）与0.29（0.19，0.39），Z=-2.335，P〈0.05]。④肌肉MRI表现为炎性水肿者外周血的Th17细胞水平高于无炎性水肿患者[10.70（4.11，14.51）个/μl与3.10（1.27，5.15）个/μl，Z=-2.460，P〈0.05]。⑤ Th17、调节性T细胞水平及Th17/调节性T细胞与病理特征（炎性细胞浸�Objective To explore the expression and their significance of peripheral Th17 cells and regulatory T cells （Tregs） in idiopathic inflammatory myopathy, and analyze the relationship between the expression and clinical indicators, imaging and pathological changes.Methods Clinical data,laboratory tests, imaging and pathological changes of IIM cases （n=85） and healthy controls （n=70） were enrolled. Clinical data included the classification, age, gender, course of the disease; laboratory tests including erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP）, creatine kinase （CK）, creatine kinase isoenzyme-MB （CK-MB）, lactate dehydrogenase （LDH）, hydroxybutyrate dehydrogenase （HBDH）. The level of peripheral Th17, Treg cells and clinical indicators, laboratory tests, imaging and pathological changes were analyzed retrospectively. Since the data was disregarded from the normal distribution, the median four quantile method was used for statistical description. Two samples were compared with Mann-Whitney U test, and the correlation between variables was Spearman rank correlation analysis. Results ① The levels of Th17 cells in the case group was not significantly different from that in the control group [6.18（3.42, 13.65） cell/μl vs 7.42（5.02, 11.13） cell/μl, P〉0.05], the levels of Treg cells in patients was significantly lower than that in the control group [21.25（12.48, 35.67） cell/μl vs 36.95（30.37, 47.12） cell/μl, P〈0.05], the ratio of Th17/Treg was also significantly higher than that in the control group [0.31（0.21, 0.47） vs 0.18（0.14, 0.31）, P〈0.05]. ② Peripheral Treg cells levels were not correlated with ESR, CRP, CK-MB, LDH and HBDH （P〉0.05）. Peripheral Treg cells levels were negatively correlated with CRP （r=-0.279, P〈0.05）, but no correlated with ESR, CK-MB, LDH and HBDH （P〉0.05）. ③ According to the involvement of important organs, patients were classified into two groups： organ involvement group and non-organ

关 键 词：T淋巴细胞 调节性 T淋巴细胞 辅助诱导 特发性炎性肌病 炎性指标 磁共振成像 肌肉活检 

分 类 号：R593.2[医药卫生—内科学]