尿酸对急性发作期痛风患者外周血中性粒细胞胞外诱捕网形成的影响及其临床意义  

Effect of uric acid on formation of extracellular trapping network of neutrophils in peripheral blood of patients with acute gout and its clinical significance

作　　者：满达夫 侯云霞[1] 李鸿斌[1] MAN Dafu;HOU Yunxia;LI Hongbin(Department of Rheumatology and Immunology,Affiliated Hospital of Inner Mongolia Medical University,Huhhot 010050,China)

机构地区：[1]内蒙古医科大学附属医院风湿免疫科,呼和浩特010050

出　　处：《山西医科大学学报》2021年第3期356-363,共8页Journal of Shanxi Medical University

基　　金：内蒙古医科大学青年创新基金项目(YKD2018QNCX081,YKD2018QNCX064)。

摘　　要：目的比较单钠尿酸盐(monosodium urate,MSU)刺激下外周血中性粒细胞胞外诱捕网(neutrophil extracellular traps,NETs)水平在痛风急性发作期的作用及其临床意义。方法收集2017年1月至2018年1月就诊于内蒙古医科大学附属医院风湿免疫科的急性发作期痛风性关节炎患者56例入组为痛风组,以及25例健康志愿者为健康对照组(HC组)。Pico Green荧光分光光度法测定血浆样品游离脱氧核糖核酸(cell-free deoxyribonucleic acid,cfDNA)含量,酶联免疫吸附剂测定法检测血浆样品中性粒细胞弹性蛋白酶(neutrophil elastase,NE)含量,比较MSU体外诱导下,痛风急性发作期与健康对照、治疗后缓解期外周血NETs生成水平的差异,以及与临床表现、实验室检查以及疾病活动性、严重性评分的相关性。结果在MSU的诱导下,痛风急性发作期患者的cfDNA、NE含量均显著高于健康对照组(P<0.01)。痛风急性期患者外周血中cfDNA、NE含量与痛风活动评分(gout activity score,GAS)和痛风影响量表(gout impact scale,GIS)呈高度的正相关性(r>0.6,P<0.01);缓解期患者外周血中cfDNA、NE含量较其急性发作期明显下降(P=0.001)。GAS与血浆NETs的变化(DNA,NE)显示中等程度的正相关性(r>0.5,P<0.01)。结论尿酸诱导痛风急性发作期患者生成循环NETs,可能参与加重痛风的炎症进程,本研究发现NETs的水平与急性发作期的疾病活动性及病情严重性呈正相关,有利于痛风病情的评价和监控。Objective To investigate the role and clinical significance of circulating neutrophil extracellular traps(NETs)induced by monosodium urate(MSU)in vitro in peripheral blood of acute gout flares.Methods Plasma samples from 56 gout patients with acute attack,who were admitted to the Department of Rheumatology and Immunology,Affiliated Hospital of Inner Mongolia Medical University from January 2017 to January 2018,were collected,and 25 healthy volunteers(HC)were chosen as control group.Levels of NETs induced by MSU,including cell-free DNA(cfDNA)and neutrophil elastase(NE)were detected by PicoGreen fluorescence spectrophotometry and enzyme-linked immunosorbent assay,respectively,and compared among healthy controls,acute gout flares and remission.The correlations of NETs with labotory examinations and disease activity were analyzed.Results Levels of NETs were significantly increased in patients with acute gout flares compared to HC controls(both P<0.01).In addition,cfDNA in acute gout flares were significantly correlated with gout activity score(GAS)and gout impact scale(GIS)(both r>0.6,P<0.01).Levels of cfDNA and NE were significantly lower in gout patients in remission than those in acute attack(P=0.001).There was a moderate positive correlation between variation of GAS and changes of NETs(ΔDNA andΔNE)(r>0.5,P<0.01).Conclusion Uric acid may induce the generation of NETs in patients with acute gout flare,which may be involved in aggravating inflammatory process.The levels of NETs are positively correlated with the disease activity and disease severity,which is favorable to the evaluation and the monitoring of gout.

关 键 词：痛风 中性粒细胞 中性粒细胞胞外诱捕网 尿酸 

分 类 号：R593[医药卫生—内科学]